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BMJ Case Rep. 2010; 2010: bcr1220092526.
Published online Sep 29, 2010. doi:  10.1136/bcr.12.2009.2526
PMCID: PMC3028089
Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Delayed diagnosis of hypopituitarism following severe traumatic brain injury
Sreedhar Kolli,1 Akhila Mallipedhi,2 Tom Hughes,3 and Peter Evans4
1Department of Rehabilitation Medicine, Rookwood Hospital, Cardiff, UK
2Department of Endocrinology, Singleton Hospital, Swansea, UK
3Department of Neurology, University Hospital of Wales, Cardiff, UK
4Department of Endocrinology, Royal Gwent Hospital, Newport, UK
Correspondence to Sreedhar Kolli, drkollisridhar2/at/hotmail.com
Abstract
The following case illustrates a 10-year delay in the diagnosis of hypopituitarism after severe traumatic brain injury in a 22-year-old man crushed by a forklift truck. His symptoms of mood changes, headaches and sleep pattern disturbances were attributed to post traumatic brain injury syndrome resulting in a delay in diagnosing the underlying pathology. Following recurrent episodes of symptomatic hyponatraemia, hypopituitarism was diagnosed. When pituitary hormone replacement treatment was given, there was clinical and biochemical improvement. There is currently very limited evidence in the literature to routinely screen patients post traumatic brain injury for pituitary dysfunction.
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