Posttraumatic panhypopituitarism with depression.

To the Editor: Hypopituitarism, also known as Simmonds’ disease, 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 leads to significant disability and endocrine dysfunction in approximately 59% of patients. Its signs and symptoms overlap with the neurological and psychiatric sequelae so often misdiagnosed. Alterations in circulating levels of hormones occur hours or days after trauma, may represent adaptive responses to injury, and are influenced by the type of injury and therapy in the acute phase of injury Endocrine manifestations of hypopituitarism reveal deficiencies of specific hormones leading to hypoadrenocorticotropinemia, hypothyroidism, and hypogonadism. Deficiency in corticotropin levels is characterized by decreased levels of adrenal androgens and decreased production of cortisol. Acute loss of adrenal function is a medical emergency and may lead to hypotension and death if not treated. Signs and symptoms of corticotropin deficiency include myalgias, arthralgias, fatigue, headache, weight loss, anorexia, nausea, vomiting, abdominal pain, altered mentation or altered consciousness, dry wrinkled skin, loss of axillary and pubic hair, anemia, and impaired gluconeogenesis. Studies have implied that pituitary dysfunction can be diagnosed years after the initial insult.