First case of chronic post-traumatic anterior pituitary dysfunction in a professional rugby player: A case report

Abstract

Background: Post-traumatic hypopituitarism has been reported as a complication in a number of contact sports. Although rugby is a sport with a high risk and high incidence of concussion, no such cases have been reported to date.

Case presentation: A 35-year-old professional rugby player presented with fatigue and reduced libido complaints after nearly 300 professional games during his 15-year career. At the end of the season, biological monitoring was performed and revealed low total testosterone level associated with a low luteinizing hormone, suggestive of central hypogonadism. Brain magnetic resonance imaging (MRI) revealed the presence of a 10-mm sequel lesion in the right medial temporal lobe and two additional punctiform lesions, all suggestive of post-traumatic brain injury lesions. Testosterone replacement therapy was initiated and the player perceived an overall decrease in fatigue and complete restoration of his libido after only a couple of weeks of treatment. During follow-up, thyrotropic deficiency was diagnosed 2 years after initial diagnosis treated by l-Thyroxin.

Conclusions: In conclusion, this case report highlights a new post-traumatic brain injury complication in a professional rugby player, namely chronic post-traumatic anterior pituitary dysfunction.

Study design: Case report; level of evidence 4.

Keywords: Concussion; Post-traumatic hypopituitarism; Rugby; Sports injury; Traumatic brain injury.