P-48 Post-traumatic Panhypopitutarism after an in-vehicle traffic accident: A case report
Authors: Demirtaş Ezgi , Dovan Pınar , Nur Kebapçı Medine , Toprak Uğur , Yorulmaz Göknur 
Published: January 2024

Abstract

Introduction
Hypopituitarism, occurs most commonly from pituitary tumors and a head injury, though a fracture of the base of the skull is considered a rare cause. Traumatic brain injury causes severe disability and endocrine dysfunction in a significant proportion of patients. Hypopituitarism diagnosed with endocrine symptoms related to hypoadrenocorticotropinemia, hypothyroidism and hypogonadism. We describe a case of posttraumatic panhypopitutarism presenting with symptoms of secondary amenorrhea, loss of appetite, nausea, vomiting, hearing loss and hypoglycemia after an in-vehicle traffic accident.

Clinical Case
A 28-year-old female patient with no medical history was admitted with symptoms of nausea, vomiting, anorexia, amenorrhea, and hypoglycemia after an in-vehicle traffic accident. It was learned that the patient's menstrual periods were regular before the accident and she did not have any complaints. Panhypopitutarism was observed in the examinations performed (Table 1). In the follow-ups, 10% intravenous dextrose solution and 20 mg prednisolone every 6 hours were started due to the hypoglycemic course. Prednisolone was reduced and discontinued, and hydrocortisone treatment was started from 30 mg/day. L-thyroxine replacement was started one week after the steroid treatment. Computed tomography (CT) showed deformity and collapse secondary to the fracture at the base of the sella and on contrast-enhanced pituitary magnetic resonance (MRI) imaging, it was observed that the morphology of the sella was distorted in T1-weighted sections, pituitary tissue could not be clearly distinguished, and there was collapse at the base of the sella in the right lateral section; the present findings were thought to support pituitary insufficiency (Figure 1). Hormone replacement therapy was given for secondary amenorrhea. One year after the accident, she wanted to be a pregnant and ovulation was induced by the injection of human menopausal gonadotrophin (HMG) following human chorionic gonadotrophin (HCG) at a large dose. She got pregnant in the first cycle.

Conclusion
In a patient with Panhypopituitarism, who could not be pregnant spontaneously, clinical practice of ovulation–induction treatment including administration of hCG and follicle-stimulating hormone, pulsatile GnRH (gonadotropin-releasing hormone), and in vitro fertilization, enabled the hypopituitary women to become ovulation and pregnancy. In our case, pregnancy was achieved after adequate hormone replacement therapy.Figure 1.CT and MRI images of the patientFigure. (a) Coronal CT section showing deformity-subsidence at the base of the sella secondary to fracture, (b and c) sagittal and coronal contrast-enhanced MRI showing subsidence at the base of the sella (thick arrow) with herniation of pituitary tissue (short arrow) and distorted-deformed infundibular stalk (thin arrow), respectively. Table 1.Laboratory workup*ACTH: Adrenocorticotropic hormone; FSH: follicle-stimulating hormone; LH: Luteinizing hormone; TSH: thyroid stimulating hormone; fT4: thyroxine; GH: Growth hormone; IGF-1: Insulin-like growth factor 1