Post-Traumatic Hypopituitarism

Struck

Step 1: View clinicals

A 16-year-old girl presents with poor growth for four years. Her growth and development were normal before this, and her appetite and food intake remain satisfactory. At age 12, she was a passenger in a motor vehicle collision, where she suffered a moderate traumatic brain injury (GCS of 12), requiring hospitalization for around a week. There were no intracranial hemorrhages and she did not require neurosurgical intervention. Her family history is unremarkable. Her performance at school is satisfactory. She has not attained menarche yet. A complete blood count, metabolic panel, liver function tests, urinalysis, and ESR are all within normal limits.


Step 2: Order all relevant investigations

Endocrine profile

TSH: 5.6 mcg/dL (5-12) Free T3: 71 ng/dL (75-200) Cortisol: 1.82 mIU/ml (2–10) FSH: 0.89 mcg/dL (5–23) LH: 1.08 mIU/ml (1–9) Estradiol: 0.31 mIU /ml (2–12) DHEAS: 0.20 ng/dL (3.4–17) Prolactin: 2.0 ng/ml (3–24) IGF-1: 1.45 ng/ml (3–24)

Pelvic ultrasound

The uterus and both ovaries are small but morphologically normal. No other abnormalities are noted.

X-ray B/L wrists

X-rays of both wrists are compatible with a bone age of 10 years.

MRI brain

T2 weighted axial sections demonstrate a slim pituitary gland located posteriorly in the sella turcica. The posterior hypophysis appears normal. These findings are consistent with partial empty sella syndrome.


Step 3: Select appropriate management

Start levothyroxine first
Start corticosteroids first
Genetic counseling
Refer her to social services


Score: ★★☆