Endocrine Abstracts

Pituitary gland has an influence on erythropoiesis. Anaemia is thought to be due to loss of thyrotrophic and adrenotrophic hormones. Testosterone is also known to stimulate erythropoiesis. Here we present a patient with long standing iron deficiency anaemia, which corrected with management of hypopituitarism.

A 72-year-old gentleman was under regular review at the diabetic clinic with type 2 diabetes mellitus. He had a background medical history of COPD, pneumoconiosis, paroxysmal AF, prostate cancer and postural hypotension. His glycaemic control was poor and was commenced on insulin along with metformin. He was found to have a microcytic anaemia, Hb10.9 g/dl, MCV, 71.3 u/l and ferritin 9 g/mmol.l. He was not vitamin B12 or folate deficient. He underwent upper and lower gastro intestinal endocscopy which did not reveal a cause. Subsequent barium enema revealed only mild diverticular disease and a CT abdomen and pelvis was unremarkable. Replacement of oral iron was not helpful. He complained of postural dizziness. A short synacthen test was performed which demonstrated a sub-optimal cortisol response, basal cortisol 217 nmol/l, 30 min post synacthen 463 nmol/l. Further analysis demonstrated hypogonadotrophic hypogonadism with ACTH deficiency. MRI head showed a normal pituitary. He was commenced on hydrocortisone and testosterone replacement with a subsequent rise in haemoglobin to 13.3 g/dl after 5 months and 15.9 g/dl, MCV 96 after 12 months.

It is important to remember the role of pituitary hormones in erythropoiesis and consider hypopituitarism in the differential diagnosis of iron deficiency anaemia. Steroid and testosterone replacement corrected anaemia in this patient however it is not clear as to which of these hormone played a major role.