Spontaneous recovery from isolated post-traumatic central hypogonadism in a woman.
OBJECTIVE
Hypopituitarism is a recognized complication of Traumatic Brain Injury (TBI). Resolution of established anterior pituitary hormones deficiency is rare.


METHODS
A woman was initially presented at the age of 22 years with amenorrhoea. Two years earlier she had been involved in a car accident with consequent TBI. At our evaluation, serum oestradiol (E2) was low (3 pmol/l), Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH) were borderline low [1.7 and 2.5 mIU/l, normal range (NR) for 20-35 yr old women being 1.4-13 and 2.5-13, respectively] with poor response to Gonadotropin Releasing Hormone (GnRH) (ΔLH = 2.4 and, ΔFSH = 4.0 mIU/l), while serum Prolactin (PRL) was elevated (951 mIU/l; NR: 102-496). No other pituitary hormone deficiencies were observed. Magnetic resonance imaging (MRI) showed a partially empty sella and very thin stalk. Ten years later a new endocrine evaluation was performed. On day 4 of her menstrual cycle, serum values of PRL (196 mIU/l), FSH (4.7 mIU/l), LH (4.8 mIU/l) and E2 (103 pmol/l) were within normal limits for women aged 20-35. Six months after this evaluation (that is, 12 years after trauma), the patient became pregnant and delivered a healthy baby.


CONCLUSIONS
Our case shows that spontaneous resolution of post-head trauma anterior hypopituitarism occur even many years after head injury. Medicolegal implications are self-evident.
Clinical Experimental Department of Medicine and Pharmacology, Section of Endocrinology, Policlinico Universitario G. Martino, University of Messina, Messina, Italy. rmruggeri@unime.it
Rosaria M
RM
Ruggeri
Giovanni
G
Smedile
Francesca
F
Granata
Marcello
M
Longo
Salvatore
S
Cannaíò
Nicholas J
NJ
Sarlis
Francesco
F
Trimarchi
Salvatore
S
Benvenga
D001930:Brain Injuries / Q000150:complications*; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone / Q000097:blood; D006801:Humans; D007006:Hypogonadism / Q000209:etiology* / Q000378:metabolism; D007986:Luteinizing Hormone / Q000097:blood; D010901:Pituitary Function Tests; D010902:Pituitary Gland / Q000000981:diagnostic imaging; D011388:Prolactin / Q000097:blood; D011877:Radionuclide Imaging; D055815:Young Adult
D007987:Gonadotropin-Releasing Hormone; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone