Abstract
We report a case of post-traumatic hypopituitarism with prolonged hypotension. The patient was 64 year-old male who transferred to our department by ambulance with unconscious state after falling down to the floor at his house. On arrival, he was comatous and presenting very shallow and weak breathing. After intubated, he underwent a CT scan of his head which revealed that he has had a subdural hematoma which required surgical removal of the hematoma. Subsequently, post-op CT scan showed extensive low density area next to pituitary gland with prolonged refractory hypotension to administration of any kinds of inotropes, therefore, we strongly suspected the secondary adrenal insufficiency due to posttraumatic hypopituitarism. All pituitary hormones except gonadtropins were below the standard level. After the administration of rescue dose of steroids, his blood pressure became stable and he was survived with induction of hypothermia therapy and hormone replacement. Recently, large numbers of reports regarding posttraumatic hypopituitarism have been publicated. Accurate evaluation and long-term follow-up of all TBI patients are necessary in order to detect the occurrence of posttraumatic hypopituitarism. It is therefore necessary that medical professionals are aware of the posttraumatic hypopituitarism in order to diagnose promptly any pituitary dysfunction. An adequate replacement therapy is indicated in the attempt to stabilitation of vital signs and to improve outcome and quality of life of traumatic brain injury patients.
