A DELAYED PRESENTATION OF POSTERIOR HYPOPITUITARISM FOLLOWING TRAUMATIC BRAIN INJURY – A CASE REPORT OF A 24 YEAR OLD ASIAN FEMALE.

Abstract

Background: Cases of post traumatic hypopituitarism are rarely contemplated in the Indian subcontinent. However global literatures disclose that the incidence rate of hypopituitarism following traumatic brain injury is around 15-30%. Most hospitals do not routinely screen patients for pituitary dysfunction following traumatic brain injury due to the lack of proper protocol supporting the same. Hence large number of cases with varying pituitary abnormalities is procrastinated, which could have been otherwise beneted from early interventions. This case is a classic example of delayed exhibition of posterior hypopituitarism post traumatic brain injury, which has signicantly compromised the quality of life of the patient in later stage due to the failure of timely screening. Case Presentation:This is a case of 24 year old female who sustained a traumatic brain injury 3 years ago allegedly due to domestic abuse. The patient presented to the urology department with the complaints of polyuria, polydipsia, secondary amenorrhea, sleep disturbance and weight gain for 6-7 months. The patient was not under regular follow-up for the traumatic injury. On further evaluation, all the anterior pituitary hormones were found to be normal. We further investigated the case with biochemical investigations and an MRI of brain (plain and contrast) which showed a thickened enhancing pituitary stalk with absence of posterior pituitary bright spot with a normal anterior pituitary gland – suggestive of Central Diabetes Insipidus. Upon initiation with Desmopressin, the patient showed signicant symptomatic improvement. Conclusion:One of the most common complications of traumatic brain injury is hypopituitarism. Early screening for hypopituitarism in such cases will help us intervene early and improve the quality of life of the patients.