Post-Traumatic Anterior and Posterior Pituitary Dysfunction

Background and Purpose: The recognition of hypopituitarism after head trauma is important because related neurobehavioral problems can be alleviated by hormone replacement. This study investigated the clinical presentations and imaging findings of patients with hypopituitarism developing after head trauma. Methods: We retrospectively reviewed the medical records of patients with hypopituitarism from 1982 through 2002. Data on disease history and hormone deficiencies of patients with hypopituitarism which developed after head trauma were analyzed. Results: Eighteen patients with hypopituitarism or diabetes insipidus (DI) due to head trauma, including 11 men and 7 women, were identified. Head trauma thus accounted for the etiology in 2.8% of all 635 patients with a diagnosis of hypopituitarism during the study period. The major cause of head trauma was road accident (n=11, 61%). Ten of the patients (56%) had lost consciousness after the head injury. The duration from head trauma to the onset of symptoms of hypopituitarism ranged from ＜1 month to 15 years. Sex hormone (61%) and growth hormone (56%) were the most common hormone deficiencies followed by corticotropin deficiency (39%) and thyrotropin deficiency (22.2%). DI developed in 9 patients (50%) and 5 of these patients had only DI without anterior hypopituitarism. Routine skull radiograph did not show abnormal signs. Among the 10 patients with magnetic resonance imaging of the pituitary gland, a small or atrophic anterior lobe was seen in patients with anterior hypopituitarism. Loss of bright signal intensity from the pituitary posterior lobe on T1-weighted magnetic resonance imaging was seen in all 3 patients with DI. An ectopic posterior lobe could be seen in 2 patients with hypopitultarism without DI. Conclusions: Identification of head trauma as the etiology of hypopituitarism may be overlooked if there is a long delay in onset after trauma. DI is a common early complication. Since anterior hypopituitarism can develop decades after the episode of head trauma, monitoring for endocrine dysfunction during follow-up of these patients is important.

並列關鍵字

Craniocerebral trauma ； Diabetes insipidus ； Diagnosis ； Hypopituiarism

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