Variable presentation of post-traumatic hypopituitarism

Post-traumatic hypopituitarism (PTHP) is defined as pituitary hormonal deficiency occurring after head injury. PTHP has recently been increasingly recognised as an important medical condition among survivors of head trauma. It can be fatal if undiagnosed, and may contribute to the morbidity and mortality associated with traumatic brain injury (TBI). Although about 75 % of PTHP cases are diagnosed within a year of TBI,1 delayed development of PTHP can also occur. Case report A 43-year-old male presented to Auckland City Hospital (Auckland, New Zealand) after an unexplained collapse and was noted to have postural hypotension with low blood pressure. A serum cortisol at 0900 hr was low at 27 nmol/L (normal, 200–700), with a low adrenocorticotropic hormone (ACTH) level suggesting secondary hypoadrenalism. Further questioning revealed a history of a significant head injury with a basal skull fracture at the age of 16 years resulting from a motor vehicle accident. Although the details surrounding this event were not available, a cranial computed tomographic scan showed an old contusion extending down to the pituitary region and an expanded third ventricle suggesting possible hypothalamic-pituitary injury. Pituitary function testing demonstrated secondary hypothyroidism and growth hormone deficiency. His gonadal axis and posterior pituitary function were normal. His symptoms improved with hydrocortisone treatment followed by thyroxine replacement therapy