Struck

A 16-year-old girl presents with poor growth for four years. Her growth and development were normal before this, and her appetite and food intake remain satisfactory.

At age 12, she was a passenger in a motor vehicle collision, where she suffered a moderate traumatic brain injury (GCS of 12), requiring hospitalization for around a week. There were no intracranial hemorrhages and she did not require neurosurgical intervention.

Her family history is unremarkable. Her performance at school is satisfactory. She has not attained menarche yet. A complete blood count, metabolic panel, liver function tests, urinalysis, and ESR are all within normal limits.

Select Relevant Investigations
Endocrine profile

Performed

TSH: 5.6 mcg/dL (5-12)
Free T3: 71 ng/dL (75-200)
Cortisol: 1.82 mIU/ml (2–10)
FSH: 0.89 mcg/dL (5–23)
LH: 1.08 mIU/ml (1–9)
Estradiol: 0.31 mIU /ml (2–12)
DHEAS: 0.20 ng/dL (3.4–17)
Prolactin: 2.0 ng/ml (3–24)
IGF-1: 1.45 ng/ml (3–24)
Pelvic ultrasound

Performed

The uterus and both ovaries are small but morphologically normal. No other abnormalities are noted.
X-ray B/L wrists

Performed

X-rays of both wrists are compatible with a bone age of 10 years.
MRI brain

Performed

T2 weighted axial sections demonstrate a slim pituitary gland located posteriorly in the sella turcica. The posterior hypophysis appears normal.

These findings are consistent with partial empty sella syndrome.

Select Relevant Management
Start levothyroxine first
Start corticosteroids first
Genetic counseling
Refer her to social services