The role of birth injury and the consequences of inadequately treated hypogonadism in longstanding panhypopituitarism.

We describe a middle-aged profoundly hypogonadal man with panhypopituitarism since infancy who was treated only with glucocorticoid and thyroid replacement. A magnetic resonance imaging study (MRI) revealed absence of pituitary stalk and ectopic neurohypophysis consistent with traumatic transection, probably resulting from a traumatic birth. The hormonal consequences of this stalk lesion were recognized but inadequately treated for 45 years resulting in avoidable endocrine and psychosocial defects. Androgen replacement was started at age 45 with good initial results. The unique hormonal replacement issues at this age are discussed.