Post-traumatic anterior and posterior pituitary dysfunction.
OBJECTIVE
The recognition of hypopituitarism after head trauma is important because related neurobehavioral problems can be alleviated by hormone replacement. This study investigated the clinical presentations and imaging findings of patients with hypopituitarism developing after head trauma.


METHODS
We retrospectively reviewed the medical records of patients with hypopituitarism from 1982 through 2002. Data on disease history and hormone deficiencies of patients with hypopituitarism which developed after head trauma were analyzed.


RESULTS
Eighteen patients with hypopituitarism or diabetes insipidus (DI) due to head trauma, including 11 men and 7 women, were identified. Head trauma thus accounted for the etiology in 2.8% of all 635 patients with a diagnosis of hypopituitarism during the study period. The major cause of head trauma was road accident (n = 11, 61%). Ten of the patients (56%) had lost consciousness after the head injury. The duration from head trauma to the onset of symptoms of hypopituitarism ranged from < 1 month to 15 years. Sex hormone (61%) and growth hormone (56%) were the most common hormone deficiencies, followed by corticotropin deficiency (39%) and thyrotropin deficiency (22.2%). DI developed in 9 patients (50%) and 5 of these patients had only DI without anterior hypopituitarism. Routine skull radiograph did not show abnormal signs. Among the 10 patients with magnetic resonance imaging of the pituitary gland, a small or atrophic anterior lobe was seen in patients with anterior hypopituitarism. Loss of bright signal intensity from the pituitary posterior lobe on T1-weighted magnetic resonance imaging was seen in all 3 patients with DI. An ectopic posterior lobe could be seen in 2 patients with hypopituitarism without DI.


CONCLUSIONS
Identification of head trauma as the etiology of hypopituitarism may be overlooked if there is a long delay in onset after trauma. DI is a common early complication. Since anterior hypopituitarism can develop decades after the episode of head trauma, monitoring for endocrine dysfunction during follow-up of these patients is important.
Su
Deng-Huang
DH
Department of Internal Medicine, Far Eastern Polyclinic, Taipei, Taiwan.
Chang
Ying-Chun
YC
Chang
Ching-Chung
CC
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000150:complications*; D003919:Diabetes Insipidus / Q000209:etiology; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D007018:Hypopituitarism / Q000097:blood / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013972:Thyrotropin / Q000097:blood
D019382:Human Growth Hormone; D013972:Thyrotropin