Post-Traumatic Panhypopituitarism in a Teenager- A Multidisciplinary Challenge

Background: Post-traumatic panhypopituitarism in children is a rare plurisymptomatic complication of traumatic brain injury, with major impact on the child’s development and quality of life. Endocrine screening after trauma is controversial.

Objective: We highlight the steps leading to diagnosis in the case of an adolescent hospitalised for unrelated pathology in order to increase awareness on this rare condition among physicians.

Methods and results: We report the case a 17-year-old boy admitted in March 2019 in „Grigore Alexandrescu” Hospital, Bucharest. The adolescent had a history of severe brain injury (age 13) due to a car accident. He was hospitalized 4 years later in the Orthopaedics Department for surgical correction of right hip chronic epiphysiolysis. The laboratory tests showed liver cytolysis, so he was transferred to the Paediatrics Department. The physical examination revealed coarse features, dry, harsh skin, coarse hair, the absence of face and body pilosity, absent secondary sex characteristics, infantile genitalia, hypopigmented skin lesions, inferior limb inequality with no other pathologic findings. Laboratory investigations showed decreasing transaminases, positive serology for EBV, low values of thyroid hormones, inadequate TSH, hypocortisolaemia, low testosterone and IGF 1. Ophthalmologic evaluation revealed post-traumatic right eye cecity. The endocrinology consult set the diagnosis of panhypopituitarism. Substitution treatment was recommended (Prednisone, L-Thyroxine, Testosterone). The cranio-cerebral MRI showed small pituitary gland, right deviated pituitary stalk, unidentifiable neurohypophysis and right optic nerve, parasphenoidal herniation of the arachnoid. Hip surgery was postponed due to potential anesthesia risks. He was referred to the Endocrinology Department for further assessment and treatment.

Conclusion: Post-traumatic rare complications such as panhypopituitarism should be considered even a long time after trauma. Focusing on solving the trauma might lead to a late diagnosis of the condition. A well-established multidisciplinary approach is needed if the child is to safely overcome any acute condition, considering the severe cortisol deficiency.