Acute secondary adrenal insufficiency after traumatic brain injury: A prospective study

OBJECTIVE:To determine the prevalence, time course, clinical characteristics, and effect of adrenal insufficiency (AI) after traumatic brain injury (TBI). DESIGN:Prospective intensive care unit–based cohort study. SETTING:Three level 1 trauma centers. PATIENTS:A total of 80 patients with moderate or severe TBI (Glasgow Coma Scale score, 3–13) and 41 trauma patients without TBI (Injury Severity Score, >15) enrolled between June 2002 and November 2003. MEASUREMENTS:Serum cortisol and adrenocorticotropic hormone levels were drawn twice daily for up to 9 days postinjury; AI was defined as two consecutive cortisols of ≤15 μg/dL (25th percentile for extracranial trauma patients) or one cortisol of