Hypopituitarism Secondary to Head Trauma

Abstract

Final Considerations Pituitary insufficiency can have life-threatening consequences. Hypopituitarism impairs adaptation to stressful events and represents a negative risk factor for the prognosis of the traumatized patient. PHTH, the characteristics of which can be summarized as in Table 3, is certainly less rare than commonly believed. Among the reasons why it can escape diagnosis, two seem to be prominent. First, the trauma may have occurred decades earlier and may also have been forgotten. This is more likely to occur when trauma was domestic, not followed by hospitalization and/or not complicated by skull fractures, loss of consciousness, or diabetes insipidus. Second, there could be lack of insistence by the endocrinologist to ask specifically for past head traumas to both the patient and his or her relatives. Of 100 endocrinologists we have inquired (unpublished data), all would associate PHTH to a complicated head trauma occurred within "days" to a "couple of years" from trauma, but none would think of interrogating the relatives. Approximately four of five endocrinologists would not consider the possibility of PHTH, should a patient with no history of posttraumatic diabetes insipidus seek consultation for symptoms compatible with pituitary insufficiency (amenorrhea, asthenia, and so on). Thus, chances are that PHTH is underdiagnosed whereas idiopathic hypopituitarism is overdiagnosed