Addisonian Crisis after Missed Diagnosis of  Posttraumatic Hypopituitarism

Werf, Christine Streetz-van der; Karges, Wölfram; Blaum, Marcus; Kreitschmann-Andermahr, Ilonka

doi:10.3390/jcm4050965

Cited by 3 publications

(4 citation statements)

References 7 publications

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“…Sin embargo, un gran número de pacientes presentan persistencia de la disfunción de la hipófisis, empeoramiento del déficit, o incluso desarrollan nuevas deficiencias (6)(7)(8). Esto ha sido reportado con periodos de latencia tan largos como 30 años después de la LCT (12) .…”

Section: Discussionunclassified

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Hipopituitarismo postraumático: reporte de un caso

Barrera

Zuluaga

2017

Rev.ACE

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Se presenta el caso de un paciente con diagnóstico de novo de hipopituitarismo, cuya manifestación inicial fue con hiponatremia grave, secundaria a una insuficiencia suprarrenal central. Adicionalmente se documentó hipotiroidismo e hipogonadismo centrales. El paciente tuvo una lesión cerebral traumática cuatro décadas atrás y se encontraron en la resonancia nuclear de hipófisis hallazgos de hipoplasia hipofisaria y aracnoidocele selar, apoyando el diagnóstico de hipopituitarismo anterior. El caso resalta la presentación de hipopituitarismo diagnosticado décadas después de una lesión cerebral traumática. Se propone un enfoque para el diagnóstico, tratamiento y seguimiento de estos pacientes en nuestro medio.Abstract We present the case of a patient with previously undiagnosed hypopituitarism, it presents whose initial manifestation was a severe hyponatremia secondary to a central adrenal insufficiency, and besides this deficit he had central hypothyroidism and hypogonadism. In his past medical history he had a moderate traumatic brain injury almost 40 years before. The case highlights the presentation of hypopituitarism decades after a traumatic brain injury. An approach to the diagnosis, treatment and follow-up of these patients in our environment is proposed.

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Section: Discussionunclassified

“…Estudios recientes revelaron que la autoinmunidad puede tener algún papel en el desarrollo y/o empeoramiento del hipopituitarismo. Se han reportado anticuerpos antihipófisis y anticuerpos antihipotalámicos en títulos altos en pacientes con hipopituitarismo luego de LCT (8)(9)(10)(11)(12)(13) .…”

Section: Discussionunclassified

Hipopituitarismo postraumático: reporte de un caso

Barrera

Zuluaga

2017

Rev.ACE

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“…However, given the fact that neuroendocrine function in patients after SAH or TBI can be considered as fluctuating to a certain degree, the indication for hormone replacement must be checked on a regular basis in order to prevent under-, but also over-treatment. This is exemplified by case reports by Agha et al [ 12 ] and Streetz-van der Werf et al [ 13 ], which highlight the consequences of over- or under-treating patients with neuroendocrine damage after TBI.…”

Section: Introductionmentioning

confidence: 92%

The Development of Neuroendocrine Disturbances over Time: Longitudinal Findings in Patients after Traumatic Brain Injury and Subarachnoid Hemorrhage

Kopczak

Krewer

Schneider

et al. 2015

IJMS

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Previous reports suggest that neuroendocrine disturbances in patients with traumatic brain injury (TBI) or aneurysmal subarachnoid hemorrhage (SAH) may still develop or resolve months or even years after the trauma. We investigated a cohort of n = 168 patients (81 patients after TBI and 87 patients after SAH) in whom hormone levels had been determined at various time points to assess the course and pattern of hormonal insufficiencies. Data were analyzed using three different criteria: (1) patients with lowered basal laboratory values; (2) patients with lowered basal laboratory values or the need for hormone replacement therapy; (3) diagnosis of the treating physician. The first hormonal assessment after a median time of three months after the injury showed lowered hormone laboratory test results in 35% of cases. Lowered testosterone (23.1% of male patients), lowered estradiol (14.3% of female patients) and lowered insulin-like growth factor I (IGF-I) values (12.1%) were most common. Using Criterion 2, a higher prevalence rate of 55.6% of cases was determined, which correlated well with the prevalence rate of 54% of cases using the physicians’ diagnosis as the criterion. Intraindividual changes (new onset insufficiency or recovery) were predominantly observed for the somatotropic axis (12.5%), the gonadotropic axis in women (11.1%) and the corticotropic axis (10.6%). Patients after TBI showed more often lowered IGF-I values at first testing, but normal values at follow-up (p < 0.0004). In general, most patients remained stable. Stable hormone results at follow-up were obtained in 78% (free thyroxine (fT4) values) to 94.6% (prolactin values).

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“…Unrecognized TBI-induced hypopituitarism may have distant consequences. In 2015, a case of Addisonian crisis due to undiagnosed PTHP was reported in a 49-year-old patient who had suffered severe TBI in a car collision 31 years earlier [63]. However, it should be strongly emphasized that endocrinological disturbances due to PTHP provoke not only physical symptoms but also affect mental health and quality of life.…”

Section: Pthp As a Challenge For Emergency Physiciansmentioning

confidence: 99%

Post-Traumatic Hypopituitarism: A Neglected Consequence of Traumatic Brain Injury

Kalas¹,

Miksiewicz²,

Kowalke³

et al. 2023

Neuroendocrinology

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Post-traumatic hypopituitarism (PTHP), described for the first time in 1918, used to be neglected and only considered a rare consequence of traumatic brain injury (TBI). The research conducted in the past 20 years, however, elucidated that it has been significantly underestimated. A PubMed search was conducted in order to find literature on the topic of post-traumatic hypopituitarism. Efforts were made to identify the wide point of view on this problem, from the historical perspective to the most recent data. The pathogenesis of PTHP is heterogenous, and various hypotheses concerning the etiology of this condition have been proposed. Unrecognized and untreated PTHP has negative socio-economic consequences and influences the quality of life. Although a few attempts to create a screening algorithm have already been performed, there is still no clear answer regarding follow-up. The prevalence of post-traumatic hypopituitarism, a rare consequence of traumatic brain injury, has been significantly underestimated in the past 20 years. The issue is multifaceted so in order to make reliable guidelines a collaboration of specialists from different fields is required. Due to the increasing prevalence of TBI, and because patients after initial treatment at emergency department usually remain under control of a neurologist, both neurologists and emergency medicine specialists should be aware of clinical picture and mechanisms of PTHP.

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Addisonian Crisis after Missed Diagnosis of Posttraumatic Hypopituitarism

Cited by 3 publications

References 7 publications

Hipopituitarismo postraumático: reporte de un caso

Hipopituitarismo postraumático: reporte de un caso

The Development of Neuroendocrine Disturbances over Time: Longitudinal Findings in Patients after Traumatic Brain Injury and Subarachnoid Hemorrhage

Post-Traumatic Hypopituitarism: A Neglected Consequence of Traumatic Brain Injury

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