Posttraumatic Panhypopituitarism With Depression

A 38-year-old man with a history of a road traffic accident 11 years ago was referred from the Medicine Department. He had been experiencing gradually increasing fatigue, decreased interest in pleasurable activities, irritability, and decreased libido for the last 10 years. He would frequently complain of nausea and headache. His symptoms gradually progressed, and he also experienced cold intolerance, constipation, malaise, arthralgia, and somnolence. Physical examination findings revealed a thin-built man, conscious and oriented, with normal vital functions. General physical, systemic, and neurological examination findings were normal. His mental status examination revealed reduced psychomotor activity, depressed affect, ideas of worthlessness, and impaired concentration. Results of laboratory testing (with reference ranges) included luteinizing hormone levels of 1.7 mIU/mL (2–12 mIU/mL), follicle-stimulating hormone levels of 6.2 mIU/mL (2–17 mIU/mL), testosterone levels of 0.01 nmol/L (6.7–28.9 nmol/L), basal cortisol levels of 0.23 µg/dL (0.39–0.69 µg/dL), prolactin levels of 0.28 ng/mL (2.5–16.7 ng/mL), free T3 levels of 1.3 pmol/L (6.5–21.0 pmol/L), free T4 levels of 1.1 pmol/L (10–23 pmol/L), and thyroid-stimulating hormone levels of 0.06 mIU/L (0.5–4.5 mIU/L).

Results on MRI brain scans revealed bilateral frontotemporal posttraumatic encephalomalacia with gliosis and ex vacuo changes, likely posttraumatic sequelae. The patient was prescribed long-term replacement therapy of hydrocortisone 20 mg twice daily and thyroxine 100 μg daily. He showed remarkable improvement.

In this case report, we emphasize the importance of an endocrine workup in patients with traumatic brain injury presenting with depressive symptoms, which can lead to early diagnosis and reduction in morbidity and mortality risks due to a misdiagnosis of hypopituitarism as a depressive disorder.