A case of post-traumatic isolated ACTH deficiency with spontaneous recovery 9 months after the event
Open accessAbstract
Survivors of traumatic brain injury (TBI) often suffer from significant adverse physical, neuropsychological, and social sequelae. TBI may pose significant risks to pituitary function;1–5 untreated hypopituitarism may aggravate these adverse consequences. Studies on the natural history of post-TBI hypopituitarism are lacking, and the reversibility of hormone deficits remains uncertain. We describe a case of a man who suffered a transient period of secondary hypoadrenalism after a serious TBI. This is the first reported case of reversible isolated adrenocorticotrophic hormone (ACTH) deficiency following head trauma. An 18 year old man was assaulted on 14 September 2003 and immediately admitted to the local accident and emergency unit with a Glasgow Coma Scale (GCS) score of 3/15 and constricted pupils. Brain computed tomography (CT) revealed multiple small bleeds involving the basal ganglia, left cerebellum, and midbrain, and a left maxilla linear fracture. No other serious injuries were found. He was ventilated on admission, supported in the intensive care unit, and 4 days later transferred to a trauma ward with an unaltered brain CT. Over the next 7 weeks, his GCS remained reduced (6–11/15) with a marked improvement after this time. During his acute recovery phase, no hypotensive insults were recorded, but he had episodes of …
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Other reports describe pituitary and hypothalamic dysfunction after TBI.
“Other reports describe pituitary and hypothalamic dysfunction,17,18”
From Loss of hypocretin (orexin) neurons with traumatic brain injury (2009) · cites this paper as [17]
The case report describes isolated ACTH deficiency after traumatic brain injury, supporting pituitary dysfunction. The Discussion mentions the hypothalamus as a possible site of injury but does not report hypothalamic dysfunction; page numbers are unavailable in our copy. (LLM, conf=0.83)
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Cites
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Lamberts, S., de Herder, W., & van der Lely, A. (1998) · The Lancet · doi:10.1016/s0140-6736(98)85043-5 · Cited by 169 · see citing works
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Research works printed but not linked: 6
- Benvenga S, Campenni A, Ruggeri RM, et al. Hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 2000;85:1353-61.
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Loss of hypocretin (orexin) neurons with traumatic brain injury
Baumann, C. R., Bassetti, C. L., Valko, P. O., Haybaeck, J., Keller, M., Clark, E., Stocker, R., Tolnay, M., & Scammell, T. E. (2009) · Annals of Neurology · doi:10.1002/ana.21836 · Cited by 185 · see citing works
“Perhaps the hypocretin neurons are injured by the same shearing forces that often damage the midbrain, but vasospasm, or elevated intracranial pressure leading to compression or reduced perfusion of the hypothalamus, may also contribute.(11,17,18) Chronic excessive daytime sleepiness is a major disabling symptom for m…”
BackgroundPrevalence and predictive factors of post-traumatic hypopituitarism
Klose, M., Juul, A., Poulsgaard, L., Kosteljanetz, M., Brennum, J., & Feldt‐Rasmussen, U. (2007) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2007.02860.x · Cited by 176 · see citing works
- Authors
- Karavitaki, N.
- Affiliations
- Royal Devon & Exeter NHS Foundation Trust (GB)
- Corresponding author
- Karavitaki, N
- ORCID
- Karavitaki, N
- Venue
- Journal of Neurology, Neurosurgery & Psychiatry
- Publisher
- BMJ
- Published
- 2006-02-01
- Volume
- 77
- Issue
- 2
- Pages
- 276-277
- ISSN
- 0022-3050 (ISSN-L)
- PMC
- PMC2077606
- OpenAlex
- W2119487293
- Cited by
- 14
- References
- 3
- Citations by year
- 2020: 1 · 2019: 2 · 2016: 1 · 2013: 1 · 2012: 1
- FWCI
- 1.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Neurology Neurosurgery & Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- isolated ACTH deficiency, traumatic brain injury, hypopituitarism, spontaneous recovery, pituitary function, assault injuries, natural history (disease)
- MeSH terms
- Adolescent, Adrenocorticotropic Hormone, Follow-Up Studies, Humans, Male, Maxillary Fractures, Pituitary Function Tests, Pituitary Gland, Remission, Spontaneous, Glasgow Coma Scale, Cerebral Hemorrhage, Traumatic
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