Endocrine Abstracts

Sarcoidosis is a multisystem granulomatous disease of unknown cause. The prevalence of neurosarcoidosis is about 5–15%. Hypothalamo-pituitary sarcoidosis is even rarer (<1% of cases evaluated for sellar and stalk lesions).

Case Report: A 33-year-old man presented to urology department with erectile dysfunction which started six months ago. Hormonal evaluation revealed gonadotropin deficiency and hyperprolactinemia (Total testosterone: 30.5 ng/dl, LH: 2 mIU/ml, FSH: 1.9 mIU/ml, PRL: 32.2 ng/ml). His sellar MRI showed uniformly thickened pituitary stalk and gadolinium-enhancement of leptomeninges, posterior limb of internal capsule, base of third ventricle, suprasellar- perioptic regions, cerebellar hemispheres and pineal gland.

His medical history uncovered that he was diagnosed as pulmonary sarcoidosis four years ago for which he didn’t receive any specific therapy and was lost of follow-up. He was diagnosed with deep venous thrombosis of lower extremity 4 months ago. Patient was put on anticoagulation therapy.

Bilateral hilar and mediastinal adenopathy was detected on thorax CT. The endobronchial ultrasound-guided transbronchial needle aspiration of hilar lymph node showed noncaseating granulomas consistent with sarcoidosis. These findings suggested a diagnosis of neurosarcoidosis with pituitary stalk involvement. This patient was treated with an initial dose of methylprednisolon (1 mg/kg/day) which was then tapered and azathioprine (150 mg/day) was added two months later because of partial response. Testosterone replacement was also initiated. MRI abnormalities regressed partially after 6 months of treatment accompanied by prolactin normalisation without any change in gonadotropin deficiency.

Conclusion: The pituitary involvement is usually associated with severity of sarcoidosis and hypogonadism is the most frequent manifestation. Sarcoidosis is also significantly associated with thrombosis risk as our case. Glucocorticoid and immunosuppressive therapy may improve MRI findings but effect on hormonal dysfunction seems to be limited. Physicians should be aware of hypothalamo-pituitary involvement of sarcoidosis since earyl treatment may rescue pituitary functions.