SPONTANEOUS-RECOVERY FROM POSTTRAUMATIC HYPOPITUITARISM

Recovery of the pituitary function from post-traumatic hypopituitarism is an exceptional event. We present the case of a 32 year-old man who was involved in a road traffic accident in which he suffered a severe head injury. Four days following the trauma the patient developed pos t-traumatic central diabetes insipidus and desmopressin was started. A t discharge of the intensive care unit, the patient was referred to us for endocrine assessment. Three months after the head injury, the hor monal evaluation of the hypothalamic-pituitary axis by means of insuli n stress test with the simultaneous administration of TRH and GnRH res ulted in a reduced responses of GH, cortisol, TSH, FSH, and LH with lo w baseline serum concentrations of free T4 and testosterone. Both seru m basal and stimulated PRL concentrations were normal. Magnetic resona nce imaging demonstrated deformity of the sella turcica with displacem ent of the pituitary gland by a post-traumatic retention cyst. A new e valuation of the pituitary function performed 6 months after the traum a showed spontaneous recovery of the gonadal, thyroid and adrenal func tion. However, GH response was reduced both to insulin-induced hypogly cemia, clonidine and GHRH tests. Presence of normal serum PRL levels, normal PRL response to TRH and reduced GH responses to pituitary and h ypothalamic stimuli suggests both hypothalamic and pituitary damage. T he present case shows an unusual case of partial spontaneous resolutio n of a post-traumatic hypopituitarism. Based on this clinical observat ion we recommend periodic evaluation of the pituitary function in thes e kind of patients.