Traumatic panhypopituitarism resulting in acute adrenal crisis

Phillip Benson Ham, Aaron Joseph Cunningham, Caleb James Mentzer, Anbar Ahmad, Lester Shinchen Young, Adel Mohamed Osman Abuzeid

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Pituitary function plays an integral role in the physiologic response to traumatic injury. A significant proportion of trauma patients develop partial pituitary insufficiency. While isolated deficiencies of individual pituitary hormones are common, there are few reports in the literature of traumatic pan-pituitary failure with deficiency of all major pituitary hormones. We present a case of a patient involved in a motorcycle accident who sustained a sella turcica fracture, epidural hemorrhage, subdural hemorrhage, optic nerve palsy, and bilateral abducens nerve palsies. Three days after the accident, the patient became hypotensive and progressed to cardiopulmonary arrest. He was resuscitated and had spontaneous return of circulation. Despite adequate fluid resuscitation and vasopressor support, he remained profoundly hypotensive. Following administration of hydrocortisone, his blood pressures dramatically improved. He was found to have laboratory abnormalities, suggesting deficiencies of corticotropins, somatotropins, thyrotropins, gonadotropins, prolactin, and antidiuretic hormone. This is the first reported case of a patient with traumatic total panhypopituitarism complicated by acute adrenal crises during initial postinjury hospitalization. A review of the literature with comparison with other studies of trauma patients with deficiencies in five or more axes is presented. A high level of suspicion for central adrenal insufficiency and prompt administration of corticosteroids in the setting of symptomatic pituitary trauma can result in favorable outcomes. Screening for and treating posttraumatic hypopituitarism can result in improved rehabilitation and increased quality of life for trauma patients.

Original languageEnglish (US)
Pages (from-to)484-489
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume79
Issue number3
DOIs
StatePublished - Sep 5 2015

Fingerprint

Wounds and Injuries
Hypopituitarism
Pituitary Hormones
Accidents
Abducens Nerve Diseases
Sella Turcica
Motorcycles
Adrenal Insufficiency
Subdural Hematoma
Thyrotropin
Optic Nerve
Heart Arrest
Vasopressins
Gonadotropins
Resuscitation
Paralysis
Prolactin
Adrenocorticotropic Hormone
Growth Hormone
Hydrocortisone

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Traumatic panhypopituitarism resulting in acute adrenal crisis. / Ham, Phillip Benson; Cunningham, Aaron Joseph; Mentzer, Caleb James; Ahmad, Anbar; Young, Lester Shinchen; Abuzeid, Adel Mohamed Osman.

In: Journal of Trauma and Acute Care Surgery, Vol. 79, No. 3, 05.09.2015, p. 484-489.

Research output: Contribution to journalReview article

Ham, Phillip Benson ; Cunningham, Aaron Joseph ; Mentzer, Caleb James ; Ahmad, Anbar ; Young, Lester Shinchen ; Abuzeid, Adel Mohamed Osman. / Traumatic panhypopituitarism resulting in acute adrenal crisis. In: Journal of Trauma and Acute Care Surgery. 2015 ; Vol. 79, No. 3. pp. 484-489.
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