Grant: Operating Grant

Damage to the pituitary gland, located at the base of the brain, is a frequently overlooked but potentially important complication of traumatic brain injury (TBI). Disorders of the pituitary gland can cause dysfunction of the thyroid, adrenals, ovaries and testes. These disorders may occur immediately or several months after TBI, may delay recovery and have a significant negative impact on quality of life. TBI is the leading cause of disability and major permanent functional impairment among adults under 45 years of age. Hormonal deficits may contribute to common symptoms experienced by TBI survivors such as fatigue, poor concentration, depression and low exercise capacity. However, the association between hormonal deficits and disability remains uncertain. The primary objective of this pilot study is to assess the feasibility of a larger study that will evaluate the impact of pituitary disorders on neurological disability and functional recovery. We will enroll 70 patients with moderate or severe TBI admitted to 6 Canadian intensive care units. Each patient will undergo hormonal and disability assessment in the intensive care unit, prior to hospital discharge, at 6 months and at 1 year. We will collect data on baseline characteristics, trauma severity, and interventions used to care for each patient. If more than 90% of patients undergo adequate hormonal and clinical assessment and if each participating center enrolls an average of 1 patient every 3 weeks, we will proceed with the larger study. Our results will provide key findings in the impact of pituitary disorders following TBI, which is a mandatory step prior testing the effect of hormonal replacement therapy in this population in costly clinical trials. 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 therapy.