Endocrine Abstracts

This 55-year-old gentleman presented to endocrine clinic following an episode of septicaemic shock complicating benign prostatic surgery one year previously. He subsequently developed symptoms of lethargy, palpitations, lightheadedness, peripheral weakness and loss of libido, which had developed after this episode. Routine biochemistry and ambulatory electrocardiography measurements were normal.

Endocrine testing revealed:: - Undetectable gonadotrophins (FSH <1.0 IU/l<1.0 IU/l)

- Low testosterone of 4.1 nmol/l (10.0–30), SHBG 35 nmol (10–62)

- Other endocrine baseline tests were within normal limits and short synacthen testing was normal.

A diagnosis of hypogonadotrophic hypogonadism was made. Gadolinium-enhanced MRI of the pituitary showed normal glandular morphology and characteristics apart from a 2.7 mm area of poor enhancement noted within the pituitary, raising the possibility of a micro adenoma. He was commenced on full testosterone replacement, with an improvement in symptoms. He is currently awaiting full pituitary assessment with an insulin tolerance test and has no symptoms suggestive of posterior pituitary dysfunction.

Acute sepsis and shock can result in varying degrees of pituitary failure from single axis failure to complete hypopituitarism following haemorrhage or infarction. In this case only the gonadotrophic axis was affected initially however ongoing monitoring of pituitary function will be required. This case highlights acute illness precipitating a degree of pituitary failure in a person with probable pre-existing benign disease. Ongoing non-specific symptoms which occur following septicaemic shock that do not resolve despite simple investigations should make one consider the possibility of subtle pituitary dysfunction.