Endocrine Abstracts

A 33 year-old male bus driver with long standing pemphigus requiring high dose prednisolone, presented with acromegaly in 2001. MRI pituitary revealed a 2×2×0.5 cm pituitary adenoma and his GH levels of 14.8–16.4 nmo/L throughout and were not suppressible with glucose. His IGF1 was 191 nmol/l (normal range: 13–64 nmol/L), Prolactin 6,557 milliunit/L, testosterone 2 nmol/L and cortisol uninterpretable as he was on prednisolone. Trans-sphenoidal hypophysectomy and external beam radiotherapy to the pituitary were undertaken in 200× with good response. He was started on levothyroxine, testosterone and the prednisolone for his pemphigus was continued. Because he remained on prednisolone, there was no opportunity or reason to check his cortisol reserve, as we presumed he would stay on prednisolone for life. In 2015 he began to respond to alternative therapies for his pemphigus that was being reviewed at another dermatological centre,were unaware of his hypopituitarism. They began to wean him off the prednisolone using a standard protocol to 5 mg, then reducing by 1 mg per month. He remained well even on 3 mg, but on 2 mg he felt very tired. When the dose was reduced to 1 mg daily, he started vomiting and was unable to go to work. Without seeking medical advice he then increased the dose and improved. He has been well since 3 mg daily and a prednisolone day curve on this dose is shown below. A SST revealed a sub-optimal response (<20, 59, 79 nmol/L).