Traumatic hypopituitarism associated with bitemporal hemianopia in a prepuberal child

Abstract

The case of a boy affected by post-traumatic hypopituitarism associated with bitemporal hemianopia is described. While traumatic bitemporal hemianopia is not an extraordinary occurence, traumatic injuries have been rarely reported among the causes of hypopituitarism. This may be because the cranial trauma in most of the cases is too severe to permit survival. After having considered the diagnostic problems the authors briefly review the peculiar vascular supply to the chiasma and anterior diencephalon and try to consider the pathogenetic mechanism of the syndrome. Direct contusion necrosis and direct intraparenchymal hemorrage in the chiasma and in the hypophysis or hypothalamus are considered the most probable causal factors; however, the concomitant occurence of chiasmal and hypopituitary injury might be explained by a single transient compressive mechanism either on the tubero-hypophysial arteries or on the smaller vessels of the infundibular network. The difficulty of ascertaining both the pathogenetic mechanism and the seat of the endocrine lesions on the basis of the clinical signs is stressed.