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Acromegaly after Traumatic Brain Injury

The Journal of Medical Case Reports recently published an article that found a high incidence of hyperpituitarism after traumatic brain injury.   It looks at a case report of a man whose acromegaly resolved itself after TBI but concludes that “there is no evidence of the presence of pituitary adenomas as a risk factor in otherwise healthy patients.”  To read original article, click here.
 

Acromegaly resolution after traumatic brain injury: a case report

Alejandro Cob 
•Correspondence: Alejandro Cob This email address is being protected from spambots. You need JavaScript enabled to view it. 
Author Affiliations
Journal of Medical Case Reports 2014, 8:290  doi:10.1186/1752-1947-8-290
Published: 2 September 2014 

Abstract (provisional)

Introduction
Anterior hypopituitarism is a common complication of head trauma, with a prevalence of 30% to 70% among long-term survivors. This is a much higher frequency than previously thought and suggests that most cases of post-traumatic hypopituitarism remain undiagnosed and untreated. Symptoms of hypopituitarism are very unspecific and very similar to those in traumatic brain injury patients in general, which makes hypopituitarism difficult to diagnose. The factors that predict the likelihood of developing hypopituitarism following traumatic brain injury remain poorly understood. The incidence of a specific hormone deficiency is variable, with growth hormone deficiency reported in 18% to 23% of cases. 
Case presentation
A 23-year-old Hispanic man with a 2-year history of hypertension and diabetes presented with severe closed-head trauma producing diffuse axonal injury, subarachnoid hemorrhage and a brain concussion. A computed tomography scan showed a pituitary macroadenoma. The patient has clinical features of acromegaly and gigantism without other pituitary hyperfunctional manifestations or mass effect syndrome. A short-term post-traumatic laboratory test showed high levels of insulin like growth factor 1 and growth hormone, which are compatible with a growth hormone-producing pituitary tumor. At the third month post-trauma, the patient's levels of insulin like growth factor 1 had decreased to low normal levels, with basal low levels of growth hormone. A glucose tolerance test completely suppressed the growth hormone, which confirmed resolution of acromegaly. An insulin tolerance test showed lack of stimulation of growth hormone and cortisol, demonstrating hypopituitarism of both axes. 
Conclusion
Even though hypopituitarism is a frequent complication of traumatic brain injury, there are no reports in the literature, to the best of my knowledge, of patients with hyperfunctional pituitary adenomas, such as growth hormone-producing adenoma, that resolved after head trauma. A clear protocol has not yet been established to identify which patients should be screened for hypopituitarism. Predictive factors that might determine the likelihood of developing post-traumatic hypopituitarism have not been clearly established, but there is no evidence of the presence of pituitary adenomas as a risk factor in otherwise healthy patients. 
The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.