Endocrine Abstracts

Traumatic thoracic injuries in children and adolescents are rare, but could be connected with others traumas, often with traumatic brain injury (TBI). Based on data in the current literature, approximately 15–20% of TBI patients develop chronic hypopituitarism. Growth hormone (GH) and ACTH deficiency are the most common, followed by gonadotropins and thyroid-stimulating hormone. The greatest challenge associated with endocrine complications in individuals with polytrauma injury is early recognition of these subtle problems. We present a case report of a 24-years-old male. In 2007 (when he was 15-years-old) the patient underwent a traffic accident, thoracic injury (hemothorax, dissection of the descending part of the aorta, aortic stent-graft implantation to the left subclavian artery) and concussion. During post traumatic period he had transient polydipsia and polyuria. In 2013 gonadal axis deficiency was confirmed. Testosterone replacement therapy was started. During current investigation low growth hormone level (GH) and insulin-like growth factor 1 (IGF-1) level were found to be low. Patient’s hight is 160 cm, mothers 158 cm, fathers 182 cm. Mid Parental Height (MPH)=173.5 cm. An insulin tolerance test (ITT) was performed. There was’t an adequate GH response-the insufficiency of somatotropic axis was confirmed. There were no others hormonal abnormalities. Further examinations e.g. NMR of the pituitary, genetic examination and DEXA are performed.

Conclusions: Physical signs such as lack of progression through puberty, with decrease in testicular volume and libido, short stature and history of after trauma transient diabetes incipidus could suggest the presence of unrecognised hypopituitarism. Careful investigation and monitoring is necessary to unmask and treat such hormone deficiencies in the transition phase.