Anterior Hypopituitarism after Traumatic Brain Injury: A Case Report

A 54-year-old man, banker by profession, presented with a three-year-history of generalized weakness, weight loss, fatigue, lethargy, irritability, decreased appetite, gastrointestinal symptoms, and sexual dysfunction. The symptoms had gradually and slowly worsened in the previous three years. He had suffered severe head injury due to road traffic accident 22 years ago and had been unconscious for 12 days. Clinical examination revealed a sick-looking, pale and dehydrated middle-aged man showing postural hypotension after standing for one minute. No significant abnormality was detected on systemic examination. Investigations demonstrated normochromic normocytic anaemia and severe deficiency of anterior pituitary hormones. Magnetic resonance imaging of the pituitary gland and of the rest of the brain was unremarkable. The patient was started on replacement therapy with hydrocortisone, thyroxine and testosterone, on which he showed remarkable improvement in his clinical condition.