Endocrine Abstracts

Introduction. We present a rare and unusual case of direct trauma to the pituitary region.

History. A 22 year old female, 8 weeks post-partum, fell downstairs on to a metallic clothes drier. A metal spike 3mm wide and approximately 20cm long penetrated her right eyebrow. Computed tomography showed a haemorrhagic track involving the hypothalamic region, and extending to the left internal capsule. Irritability and instability of vital signs necessitated intubation and ventilation. Diabetes insipidus was noted on the Intensive Care Unit, with urine volumes exceeding 6 litres in 24 hours, plasma sodium 162mmol/l, and urine osmolality 288mOsm/kg.

Endocrine Tests. Basal tests at 10am revealed anterior pituitary insufficiency: Cortisol 162 nmol\/l, ACTH 20 ng\/l, LH<0.1u\/l, FSH 0.6 u\/l, FT3 2.7 pmol\/l (4-8), FT4 8.2 pmol/l (10-23), GH 1.2 mu/l.

Management. DDAVP, hydrocortisone and thyroxine were commenced. Complete adipsia, confabulation and absent short term memory caused difficulty in managing fluid balance and hormone replacement.

Outcome. Three months later normal menstruation recommenced. Thyroxine was withdrawn at 3 months, hydrocortisone at 6 months and DDAVP at 14 months. Thirst sensation returned at 6 months. Synacthen, TRH and GnRH tests all became normal. At no time were visual fields, acuity and motor function affected.

Discussion. A freak accident, which might easily have blinded the right eye, caused pan-hypopituitarism. Subtle neuro-psychological abnormalities persisted, but pituitary function recovered completely.