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Pituitary deficiencies following head injury – a patient case

Pituitary deficiencies following head injury – a patient case. Sue Cox Endocrine CNS Torbay hospital. Patient. 42 year old male Married Unemployed Ex smoker Moderate alcohol. Medical History. Hayfever Crush injury right arm Asymptomatic proteinuria

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Pituitary deficiencies following head injury – a patient case

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  1. Pituitary deficiencies following head injury – a patient case Sue Cox Endocrine CNS Torbay hospital

  2. Patient • 42 year old male • Married • Unemployed • Ex smoker • Moderate alcohol

  3. Medical History • Hayfever • Crush injury right arm • Asymptomatic proteinuria • Familial hypercholesterolaemia (Jan 06) • Assault 1994 - #skull and left frontal subdural haematoma • Legionnaires 2005 • DVT 2005

  4. Presentation • Oct 04 (approx 2 weeks after head injury) • Polydipsia 15-20 pints/day • Polyuria • Nocturia 1-10/night (avg 3-4) • Tired, cold • Headaches • Loss of smell and taste • Loss of appetite

  5. 24 hour urine volume Urine osmolality* Serum osmolality* Sodium FSH LH Testosterone Cortisol TSH IGF-1 MRI 5.25L 106 (0 -1400) 311 (281 – 297) 151 (132 – 144) 3.2 (0 – 10) 5.6 (0 – 10) 15.79 (8 – 29) 419 (10.00 am) 1.80 (0.35 – 5.5) 156 (90 – 360) Normal appearance of pituitary Investigations

  6. Conclusion • Cranial Diabetes Inspidues secondary to head injury • Started Desmopressin • Urine volume improved – 1.5 L • Drinking less • Nocturia resolved • However………………

  7. There’s more • Dec 06 • Limb weakness • Memory problems • Dizziness • General fatigue • Tiredness • CT scan • Cerebral atrophy & left frontal lobe damage • Synacthen test = normal • Gonadotrophins and testosterone = normal • Free T4 – low 9.4 (n = 11-24)

  8. Feb 07 • Free T4 = 10 • Start T4 50 mcg • Plan for GH stimulation test • GHRH/Arginine (Sept 07) • Peak GH = 37 • IGF-1 = 248 (9 – 40) • ?? False negative • Proceed to Glucagon • Peak GH = 0.9 (mu/l) • IGF-1 = 18.1 • AGDHA score = 24/25

  9. Where are we now • Desmopressin 200 mcg tds • T4 50mcg od • Cortisol = normal response during Glucagon • Testosterone normal • Started GH replacement March 08 • IGF-1 – normalised June 08

  10. Any questions?

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