Endocrine Abstracts

We present the case of a patient diagnosed with panhypopituitarism at an adult age. The tenth child of a poor family, PA consulted the endocrinologist accompanied by his 65 year old mother. PA was 20 years old at the first consultation. He was, however, entrapped in the body of a 12 year old child, being only 139 cm tall and having no signs of puberty onset. He was slightly eunuchoid, with long limbs, due to delayed puberty, with micropenis and lack of androgen dependent hair, but otherwise harmoniously developed. He had low blood pressure and hypoglycemia. His skin was pale, dry and slightly carotenic and infiltrated and his scalp and eyebrow hair was scarce. His clinical appearance was very suggestive for panhypopituitarism. Clinical supposition was confirmed by hormonal investigation: a low IGF1 (38 ng/ml, normal 250–600 ng/ml) and low basal GH (0.1 ng/ml, normal >10 ng/ml), which didn’t increase at effort, insulin or clonidine tests, demonstrating a GH deficiency. TSH and fT₄ were below the normal limit, basal morning cortisol was low (5 μg/dl) and it maintained low values even after insulin stimulation. The tests revealed also a gonadrotopic deficiency, with prepubertal LH, FSH and testosterone. MRI investigation showed partial empty sella, ectopic neurohypophysis and hypoplastic pituitary stalk (described midline effect accompanying GH deficiency in children). After 3 years of treatment with recombinant GH, thyroid hormones and glucocorticoids, the patient gained 20 cm in height, the clinical aspect improved, as well as the paraclinical values. At the moment, he also undergoes injectable testosterone treatment thereby growing five extra centimeters (final stature 174 cm) and developing secondary sexual characteristics. This case pleads in favor of GH therapy in panhypopituitary patients irrespective of the age of diagnosis with potential beneficial effects on growth.