Clinical review 113: Hypopituitarism secondary to head trauma.

Abstract

In a classic article published in this journal more than 50 yr ago, Escamilla and Lisser (1) reported that head trauma accounted for hypopituitarism in only 4 of 595 patients (0.7%). In the following 19 yr, Altman and Pruzanski (2) collected 15 additional cases of posthead trauma hypopituitarism (PHTH) from the international literature. In the subsequent 25 yr, Edwards and Clark (3) collected 34 new cases, so that their review concerned a total of 53 cases. No subsequent review on PHTH has appeared thereafter. After our initial observation of the first genuine case of posttraumatic isolated hypogonadotropic hypogonadism (4), namely the posttraumatic selective damage of the gonadotrophs, we became alerted about PHTH. Our experience with this patient (4) proved to be fruitful, because it helped us to diagnose PHTH—rather than “idiopathic” hypopituitarism—in subsequent patients (5). We learned, in fact, that head trauma can be minor and had occurred several years earlier, so that the patient may lose recollection of it. Thus, we learned to help the patient (and his or her relatives) to recollect these traumas. In addition to screening the literature from 1986 through 1998, we also screened the years 1970–1985 to ensure that Edwards and Clark (3) had not missed some cases, as indeed they did (6–13). Thus, we bring the total of PHTH cases to 367, namely 314 more than the 53 cases reviewed by Edwards and Clark (3). The 314 cases (4–26) include our own 15 cases (Refs. 4 and 5 and our unpublished data), but not the 11 cases reported by Cytowic and Smith (27) in a letter to the editor because of the selectivity of their series (all women who had developed amenorrhea) and the lack of hormone measurements. We warn the reader that not all the articles report all the relevant parameters that we will review, so that the resulting prevalences have different denominators. The aim of the present review is to assess the epidemiological, clinical, and endocrinological features of hypopituitarism following head trauma. Generalities