Journal of the Formosan Medical Association
Volume 105, Issue 7 , Pages 536-541, 2006

Hypopituitarism: A Sequela of Severe Hypoxic Encephalopathy

  • Kuo-Meng Liao

      Affiliations

    • Zhongxiao Branch, Taipei City Hospital, Chung-Hsiao Municipal Hospital, Taipei, Taiwan
    • ,
  • Huan-Wen Chen

      Affiliations

    • Lo-Tung Poh-Ai Hospital, Yilan, Taipei, Taiwan
    • ,
  • Tien-Shang Huang

      Affiliations

    • National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Tien-Shang Huang, Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 100, Taiwan

Department of Internal Medicine, Far Eastern Polyclinic, Taipei, Taiwan

Received 19 September 2005; received in revised form 15 November 2005; accepted 10 January 2006.

Article Outline

Background/Purpose

Central diabetes insipidus (DI) is an established phenomenon after hypoxic encephalopathy or brain death, but hypopituitarism is seldom described. This study investigated the characteristics of 11 patients with DI and hypopituitarism which developed after severe hypoxic encephalopathy.

Methods

The medical records of patients with DI and hypopituitarism after severe hypoxic encephalopathy from 1997 to 2002 were retrospectively reviewed. Eleven patients with DI and hypopituitarism after severe hypoxic episodes were included. Demographic data, primary diagnosis, the time of onset of DI, the time of diagnosis of hypopituitarism, the presence of symptoms of hypopituitarism, and outcome of these patients were analyzed.

Results

Eleven patients comprising nine females and two males aged 47.4 ± 19.3 years (range, 24-74 years) were included. The mean interval from the precipitating event to the onset of DI was 60 ± 46 hours (range, 11-131 hours). The mean interval from the precipitating event to the diagnosis of hypopituitarism was 423 ± 182 hours (range, 132-672 hours). The average duration of hospitalization was 63 ± 35 days (range, 9-113 days). The overall mortality rate during hospitalization was 45%. Four patients died of sepsis and one died of heart failure due to acute myocardial infarction.

Conclusion

The development of DI after severe hypoxic encephalopathy is a sign of severe brain damage. It usually ensues immediately or days after loss of brain stem reflexes. Hypopituitarism developed several weeks later than DI in these patients. Recognition and treatment of these deficiencies may prevent organ dysfunction.

Key Words:  brain death , diabetes insipidus , hypopituitarism , hypoxic brain , hypoxic encephalopathy

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PII: S0929-6646(09)60147-9

doi:10.1016/S0929-6646(09)60147-9

Journal of the Formosan Medical Association
Volume 105, Issue 7 , Pages 536-541, 2006

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