Endocrine Abstracts

Introduction: Idiopathic Pituitary atrophy is rare cause of pan hypopituitarism. Various hypotheses were proposed to identify aetiology of idiopathic pituitary atrophy. Still definite cause is not known. There are very few reported cases of pituitary atrophy. We present a case of pituitary atrophy that required complete replacement of pan hypopituirsm to alleviate her symptoms.

Case report: About 64 year lady was referred for evaluation of hyponatraemia and tiredness. She was known have Asthma, Hypothyroidism, osteoporosis and auditory hallucinations. Investigation revealed adrenal insufficiency with basal cortisol of 106 mmol per litre going up to 166. Her tiredness did not improve despite of adequate thyroxine and steroid replacement. There was no postural hypotension and serum sodium was normal. Pituitary profile revealed normal prolactin but hypogonadotropic hypogonadism and low IGF1. (IGF1-6.9, normal range=10–28.4) MRI Pituitary showed pituitary atrophy with no mass or empty Sella. Surprisingly there was no evidence of pituitary atrophy in computerised Tomography of head done a year back. She had glucagon stimulation test instead of insulin tolerance test due to her age. Test showed impaired growth hormone and cortisol response with peak Growth Hormone level of 0.1 mcg/l (normal response 7 mcg/l). Her AGHDA (Assessment of GH Deficiency in Adults) score was high at 25. She was started on Growth Hormone replacement according to NICE guidelines. She has shown good response to treatment. Her AGHDA score improved.

Discussion and Conclusion: Diagnosis of Growth hormone deficiency can be challenging in advanced age group patients. However it is quite rewarding to see symptom improvement due to full replacement of pan hypopituitarism including growth hormone. We still don’t have better understanding of underlying mechanism for pituitary atrophy which is a rare cause of pan hypopituitarism.