{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T10:30:38Z","timestamp":1778841038088,"version":"3.51.4"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2018,3,2]],"date-time":"2018-03-02T00:00:00Z","timestamp":1519948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2018,5]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Biochemical diagnosis of adrenal insufficiency (<jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content>) is difficult in the context of traumatic brain injury (<jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the frequency and predictive factors of <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> in victims of <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content> from Algiers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between November 2009 and December 2013, <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content> victims had a single 8\u20109\u00a0<jats:sc>am<\/jats:sc> serum cortisol measurement during the acute postinjury period (0\u20107\u00a0days). <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> was defined according to basal cortisol levels of 83, 276 and 414\u00a0nmol\/L. Variables studied were <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content> severity according to Glasgow coma scale, duration of intubation and coma, pupillary status, hypotension, anaemia, brain imaging findings, diabetes insipidus and medication. Insulin tolerance test was performed during the recovery phase, defining <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> as peak cortisol &lt;500\u00a0nmol\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Cortisol samples were obtained at median 3 (1\u20107) days from 277 patients (257M: 20F) aged 32 (18\u201065) years. Acute <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> frequency was 8 (2.8%), 20 (21%) and 35 (37%), respectively using the three cortisol cut\u2010offs. Factors predicting <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> were diastolic hypotension<jats:italic>,<\/jats:italic> sedative medication, diabetes insipidus, skull base fracture and intraparenchymal haematoma. Mortality was highest in patients with acute cortisol &lt;276\u00a0nmol\/L (44.6% with <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> for death 1.64, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.92\u20103.0, <jats:italic>P<\/jats:italic>\u00a0=\u00a0.12). During the recovery phase, <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> was present in 3 of 3, 12 of 24, 4 of 16 and 20 of 66 patients with week 1 cortisol &lt;83, 83\u2010276, 277\u2010414 and &gt;414\u00a0nmol\/L.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hydrocortisone replacement is advised in <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content> patients with morning cortisol &lt;276\u00a0nmol\/L or those &lt;414\u00a0nmol\/L with additional risk factors for <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content>. As acute and subsequent <jats:styled-content style=\"fixed-case\">AI<\/jats:styled-content> are poorly correlated, patients with moderate\/severe <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content> require adrenal re\u2010evaluation during the recovery phase.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.13562","type":"journal-article","created":{"date-parts":[[2018,2,6]],"date-time":"2018-02-06T04:45:06Z","timestamp":1517892306000},"page":"627-636","source":"Crossref","is-referenced-by-count":25,"title":["Cortisol evaluation during the acute phase of traumatic brain injury\u2014A prospective study"],"prefix":"10.1111","volume":"88","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5787-6076","authenticated-orcid":false,"given":"Meriem","family":"Bensalah","sequence":"first","affiliation":[{"name":"Endocrinology Unit Central Hospital of Army  Algiers 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