PAUL D. WOOLF, M.D.; DON S. SCHALCH, M.D.
One year after a basilar skull fracture suffered in an automobile accident, a 21-year-old woman was found to have profound hypopituitarism, with normal pituitary responsiveness to thyrotrophin-releasing hormone. Her base-line thyrotrophin, Cortisol, growth hormone, and urinary 17-hydroxysteroids were undetectable. The plasma follicle-stimulating hormone and luteinizing hormone were at the lower limits of normal; plasma thyroxine was in the hypothyroid range. Provocative testing of the pituitary-end organ axis by clomiphene citrate, insulin-induced hypoglycemia, and metyrapone was without effect. Nevertheless, her basal plasma prolactin was markedly elevated, and both circulating thyrotrophin and prolactin increased after the intravenous administration of 100 µg of synthetic thyrotrophin-releasing hormone, which indirectly documents abnormal hypothalamic function. This patient's hypopituitarism was secondary to either hypothalamic insufficiency or interruption of the hypothalamic-hypophyseal-portal circulation.
WOOLF PD, SCHALCH DS. Hypopituitarism Secondary to Hypothalamic Insufficiency. Ann Intern Med. ;78:88–90. doi: 10.7326/0003-4819-78-1-88
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Published: Ann Intern Med. 1973;78(1):88-90.
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