Facteurs de risque et conséquences des troubles hypophysaires chez les victimes de traumatisme craniocérébral modéré et grave


François Lauzier

Centre de recherche du CHA - Hôpital de l'Enfant-Jésus


Domaine : neurosciences, santé mentale et toxicomanies

Programme consortium pour le développement de la recherche en traumatologie- volet 1

Concours 2014-2015


Ministère de la Santé et des Services sociaux
Société de l'assurance automobile du Québec
Réseau privincial de recherche en adaptation-réadaptation
Association québécoise d'établissements de santé et de services sociaux
Associtation des établissements de réadaptation en déficience physique du Québec

Traumatic brain injury (TBI) is the leading cause of disability among adults under 45 years of age. Over a third of the survivors suffers from major functional impairment, which can be permanent, and consumes enormous community-based primary healthcare resources. Damage to the pituitary gland, located at the base of the brain, is a frequently overlooked complication of TBI. Pituitary disorders cause thyroid, adrenals, ovaries and testes dysfunction and may have a negative impact on quality of life and recovery rate. Common symptoms among TBI victims such as fatigue, poor concentration, depression and low exercise capacity may be related to hormonal deficits. However, the association between hormonal deficits and disability after TBI remains uncertain.

The primary objective of this study is to assess the impact of pituitary disorders on neurological disability and on the functional recovery of moderate and severe TBI victims. We will enroll 99 patients admitted to 3 Québec intensive care units. We will collect information on baseline characteristics, trauma severity, and TBI management. A magnetic resonance imaging of the pituitary gland will be performed 7 days following TBI. Each patient will undergo hormonal testing and disability assessment prior to hospital discharge and at 6 months. We anticipate that our results will provide key findings to help understanding pituitary disorders following TBI. If we demonstrate that pituitary disorders affect neurological prognosis or functional status, our results will justify the need to implement a screening strategy for this population.

Our results will therefore inform the design of multicenter randomized controlled trials to evaluate the efficacy of hormonal replacement therapy in these patients. If no relationship between pituitary disorders and disability is observed, our findings will prevent unnecessary, time consuming and costly hormonal screening and will discourage potentially harmful hormonal replacement therapy.