Addisonian Crisis after Missed Diagnosis of Posttraumatic Hypopituitarism.

Christine Streetz-Van Der Werf,Wolfram Karges,Marcus Blaum,Ilonka Kreitschmann-Andermahr

doi:10.3390/jcm4050965

Christine Streetz-Van Der Werf, Wolfram Karges + Show 2 more

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https://doi.org/10.3390/jcm4050965

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Abstract

We report a case of a previously undiagnosed panhypopituitarism initially presenting as a full-blown Addisonian crisis with hypoglycemia, hyponatremia, hypotension and neuropsychological symptoms, more than 30 years after a severe traumatic brain injury (TBI). The patient also displayed clearly visible pathognomonic clinical signs of long-standing pituitary dysfunction. The case highlights the importance of being aware of endocrine sequelae even decades after serious TBI.

Highlights

In the last two decades, traumatic brain injury (TBI) as a major and perhaps formerly underestimated cause of hypothalamic-pituitary dysfunction has been intensely researched and discussed in the medical literature
Clinical history revealed no other anamnestic information beside the TBI that could be related to a loss of pituitary function
To the currently reported patient, he subsequently developed loss of secondary hair growth and progressive cachexia and was investigated for these problems many years after the injury. Despite this and other early clinical descriptions of posttraumatic hypopituitarism [6], TBI as a clinically relevant cause of hypothalamic-pituitary dysfunction has only recently come into the focus of attention ([1,3,6] and the current JCM issue)

Summary

Introduction

In the last two decades, traumatic brain injury (TBI) as a major and perhaps formerly underestimated cause of hypothalamic-pituitary dysfunction has been intensely researched and discussed in the medical literature (for an overview see [1,2,3]). Despite the attention this topic receives in scientific journals, routine testing for endocrine dysfunction in TBI survivors is still rarely performed. It is likely that many cases of posttraumatic hypopituitarism remain undiagnosed and untreated, with potentially life-threatening consequences for the affected patients as illustrated in the reported case

Case Report

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