Endocrine Abstracts

Background: Pituitary haemorrhage or infarction into a pituitary tumour is well reported unlike isolated Pituitary haemorrhage due to traumatic injury of a normal gland.

Case report: A previously healthy 44-year-old man presented following two episodes of seizures following a closed head injury. He reported transient extreme thirst, polyuria and headache at the outset, which had resolved by the time of admission. His Glasgow Coma scale was 14/15 and his clinical examination showed frontal bruising to his head but was otherwise normal with no focal signs. One week prior to admission he had been diagnosed with Acute Psychosis requiring restraint and admission to a Mental Health unit. MR Imaging of his brain revealed high T1 signal within the pituitary gland suggestive of an isolated pituitary heamorrhage. Short Synacthen test; baseline 205 nmol/l and 408 (30’) (Abott assay N 30 mins > 450 nmol/l). The rest of his pituitary hormone profile was within normal limits. Infective and other infalmmatory causes were excluded by normal CSF findings. The patient made satisfactory progress with appropriate management of his acute psychosis and maintaenance hydrocortisone replacement.

Discussion: Due to the anatomical location of the pituitary gland as well as the long hypophyseal portal vessels, the pituitary is vulnerable to direct mechanical trauma (1).

Pituitary adenomas are more prone to blled than a normal pituitary gland, due to diferences in blood supply (2).: Trauma related Pituitary haemorrhage requires a high index of suspicion to enablr accurate diagnostic work up and corection of hormone deficiences to ensure a satisfactory recovery (1).

References

1. Tanriverdi F et al; Pituitary Dysfunction After Traumatic Brain Injury: A Clinical and Pathophysiological Approach, Endocrine Reviews, Vol. 36, Issue 3, June 2015, Pages 305–342.

2. Briet C et al; Pituitary Apoplexy, Endocrine Reviews, Vol. 36, Issue 6, December 2015, Pages 622–645.