The typical patient with post-traumatic hypopituitarism is a young adult male 
presenting months to years after an automobile accident, following which he was 
unconscious for several days. He will probably have sustained a fracture of the 
base of the skull and on recovery is likely to have permanent visual or other 
neurological sequelae. Temporary or permanent diabetes insipidus may have 
occurred. The features of panhypopituitarism such as weight loss, fatigue, 
faintness, loss of libido, and impotence may have been ascribed to depression or 
the "postconcussion syndrome" and often inappropriate treatment and 
rehabilitation advised. The striking feature on review of the literature is that 
the pathological consequences of head injury to the pituitary and hypothalamus 
have been well described, while only 47 cases of traumatic hypopituitarism have 
been reported. The most likely reason for this disparity is that head injury of 
sufficient severity to cause hypothalamic and pituitary damage commonly led to 
death. More patients now survive, owing to the availability of intensive care; 
accordingly, most cases have been reported in the last 15 years. However, 
several patients are described in whom the initiating head injury was not 
associated with a skull fracture or followed by coma. We recommend that patients 
with major head injury (defined by post-traumatic amnesia greater than 24 
hours), and in particular those with fractures of the base of the skull or 
diabetes insipidus should be closely monitored for symptoms and signs of 
endocrine dysfunction and appropriate dynamic pituitary-function tests 
performed.