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Letters to the Editor |
Cattedra di Endocrinologia Dipartimento Clinico-Sperimentale di Medicina e Farmacologia Patologie Internistiche e Farmacologia Clinica Università degli studi di Messina 98125 Messina, Italy
To the editor:
We welcome the comments by Dr. Henkin and, indeed, we thank him for having alerted us about possible additional consequences of head trauma. Mention of alterations of smell and taste acuity is lacking in the case reports, including our own 15 cases of post head trauma hypopituitarism (PHTH) that we have reviewed (1) and also including the penultimate review on PHTH (2). This review (2) followed by 12 yr the Shechter and Henkin recognition of smell and taste abnormalities after head trauma (3). In the time allotted us to respond to Dr. Henkin, we have not been able to review this and other articles from his experience. In particular, we would like to know whether the smell and taste abnormalities were revealed only on challenging tests or were subjectively complained by the patients. Did those abnormalities follow major, minor, or either type of head trauma?
By citing personal studies published in the mid 1960s and 1970s (4, 5, 6), Dr. Henkin reports that both hypoadrenalism and hypothyroidism can cause impaired ability to recognize odors and smells, and that these alterations may be corrected by the replacement hormone treatment. However, not only did he not ascertain whether his posttraumatic patients who had smell/taste abnormalities were hypopituitaric but also he did not test whether those who did not have abnormalities were eupituitaric. Without these crucial investigations for specificity, the link between those abnormalities and PHTH remains somewhat elusive, although probable. These investigations would be of interest also because if, indeed, the link exists and subjective symptoms of altered smell/taste are present, then one can isolate a subgroup of patients with history of head trauma who carry a high likelihood of harboring PHTH.
Finally, by citing his chapter in a book (7), Dr. Henkin states that "as many as 60% of patients with head injury may experience loss of smell," and he contrasts this prevalence with that of PHTH ["... many fewer patients may experience hypopituitarism"]. We have now collected several additional cases of PHTH, so that we disagree with him. As stressed in our review (1), PHTH is only seemingly rare. Head trauma may have occurred even decades before and have been so minor that the patient can lose recollection of it. Unless there is much insistence by the physician who takes the patient’s history so as to carefully permit the patient (and his/her relatives) to remember previous head trauma(s), the false concept of the extreme rarity of PHTH will perpetuate.
Received December 18, 2000.
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