ESPE Abstracts

Background: Hypopituitarism, which is a heterogeneous disorder with diverse underlying etiologies, has been increasingly recognized following traumatic brain injury.

Objective and hypotheses: In some patients, central fever associated with GH deficiency have been rarely reported. In this case report we presented a case with central fever associated with GH deficiency.

Method: A 7-year-old boy, who was involved in a traffic accident, presented with coma. Multiple skull fractures, hydrocephalus, pneumocephalus and subarachnoid hemorrhage were present on cranial computed tomography.

Results: On the second day following head trauma, he was diagnosed with central diabetes insipidus (DI), and desmopressin treatment was initiated. Owing to the presence of DI, anterior pituitary functions were investigated and revealed central hypothyroidism and hypocortisolism. Treatment with hydrocortisone and L-thyroxine, was initiated. During the past 6 months, he also had recurrent episodes of a prolonged febrile illness of unknown origin. All investigations related to infectious, autoimmune and neoplastic diseases were negative and the fever was considered to be of central origin. On follow-up, the patient had a decreased height velocity together with reduced IGF 1 and IGFBP 3 concentrations and insufficient growth hormone (GH) responses in two provocative tests thus GH deficiency was confirmed. He was started on rhGH at a dose of 25 μg/kg per day. On the fifth day of the rhGH treatment, his fever was controlled.

Conclusion: It has recently been shown that patients with GH deficiency have a reduced sweating capacity which increases the risk of developing hyperthermia. This case report describes a patient with prolonged febrile illness of unknown origin, who presents with GH deficiency possibly due to a previous head trauma. With this report, we would like to emphasize that in cases with a fever of unknown origin and traumatic brain injury, GH deficiency should be considered, and complete pituitary evaluation should be performed.