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Master Thesis

Insuffisance surrénale sévère à la phase aiguë des traumatismes crâniens en réanimation‎

Abstract : Objective : To determining the prevalence and predisposing factors of severe adrenal insufficiency (SAI) after traumatic brain injury (TBI) during the acute post-injury period in intensive care unit. Study design : Prospective cohort study. Patients : The study concerned 48 patients hospitalized in intensive care unit from April 2007 to july 2008 following a TBI (3-14 Glasgow score). Methods : Endocrinal assessement was systematically performed between J2 and J5 after TBI : basal cortisol level and 250 µg tétracosactide (synacthène®) stimulation test, TSH, T3L, T4L, prolactine and IGF-1. SAI was defined by cortisol,level <138nmol/1 (5 µg/dl). Comparisons between groups were based on Chi2 and Mann-Whitney tests. Results : 16/48 patients had an early SAI. 12 of 15 SAI subjects responded to synacthene® test, demonstrating the central origin of their global outcome (Glasgow Outcome Scale) was less favorable (p=.034) compared with patients without SAI. Those with SAI had more frequent intracranial hypertension (ICHT) phases (p=0.022), needed higher dose of dobutamine (p=.015), and required more often thiopental infusion (p=.005) or osmotherapy (p=.014). On CTScan, bilateral (p=.0005) and frontal (p=.005) contusions were associated with SAI. Conclusion : This work reports a high occurrence of early SAI post TBI which is associated with poor outcomes. SAI most likely takes place in the pituitary gland. These results raise the question of SAI's responsibility in neurologic prognosis, due to systemic secondary brain injury, and furthermore the question of screening and substitution of ISS in acute phase post TBI.
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Master Thesis
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Jérôme Normand. Insuffisance surrénale sévère à la phase aiguë des traumatismes crâniens en réanimation‎. Médecine humaine et pathologie. 2010. ⟨dumas-00628227⟩

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