Endocrine Abstracts

Background: Head trauma of sufficient severity, particularly causing fracture to the skull base, can cause deficient secretion of anterior pituitary hormones and vasopressin. Severe hypopituitarism and diabetes insipidus (DI) are common post-traumatic events but they can recover 3 and 12 months afterwards.

Objective: To report a case of a woman with post-traumatic hypopituitarism and DI after car accident.

Case report: A 31 year old woman, was victim of a car accident three months ago, with fracture of the base of the skull following which she was admitted in ICU. A cerebrospinal fluid rhinorrhea remitted spontaneously, and the patients presented with a transient episode of polyuria. After recovery she was discharged without any pituitary substitution therapy. At admission in our Endocrine Dpt. after 3 months, she had progressive fatigue, faintness, diarrhoea, secondary amenorrhea. Pituitary MRI showed a focal anterior pituitary lesion compatible with a subacute hematoma. Clinic and laboratory examination revealed hypopituitarism: central hypothyroidism (TSH=0.0197 uUI/ml, FT4=10.05 pmol/l), low IGF-1=21.22 ng/ml, hypocortisolism (ACTH=1pg/ml, cortisol in the morning (8AM) =3.84ug/dl); hypogonadotropic hypogonadism, (FSH=0.86mUI/ml, LH=0.23mUI/ml, Estradiol=10pg/ml), normal prolactin, (6.14 ng/ml), hyponatremia, hypokalemia, anemia (Hb=10,7g/dl) and inflammatory syndrome (VSH=39.4mm/h). After starting the correction of cortisol deficiency the subclinical central diabetes insipidus was gradually exposed, leading to polyuria (6.5 l urine/day, spontaneous urine osmolality=81 mOsm/kg, plasma osmolality=293 mOsm/kg). In addition to hydrocortisone we started DDAVP and LT4 with net improvement of the clinical condition.

Conclusion: Posttraumatic diabetes insipidus is devoid of clinical signs in the absence of adequate adrenocortical function. Progressive substitution leads to clinical expression of DI. We recommend that patients with major head injury, especially those with fractures of the base of the skull, should be closely monitored for symptoms and signs of endocrine dysfunction. Regular follow-up is then recommended to monitor for possible remission of the pituitary deficits.