Endocrine Abstracts

Fifty-five years old patient with background of type 2 DM, referred by the GP with low serum Cortisol levels (<50), when was investigated for his ongoing symptoms of tiredness with low energy level. He also noticed reduced sexual drive and erectile dysfunction worsening over years along with reduced shaving frequency, to twice a week and sparse hair growth on his body. He denied any trouble with his peripheral vision or any significant headaches, but did feel dizzy on occasions He maintained a good glycemic control since his diagnosis was made around 10 years, with metformin alone. He denied using any anabolic steroids, and had a short course of oral steroids for his acute severe asthma around 10 years ago.

Past medical history: Other than Type 2 DM he had surgical removal of his left maxillary bone tumour around 20–30 years earlier with enucleation of his left eye followed by radiotherapy sessions. Examination was significant for sparse body hair distribution,low testicular volume and enucleated left eye but no visual field defect on confrontational method of his right eye.

Results and treatment: Pituitary Functions IGF1: 4.6 (NR 7.0–25.6) FSH: 0.8 LH:<0.2, TSH: 0.01: Prolactin: 301(NR 86–324) Testosterone: 5.2 (NR 9.9–27.8) Short synecthen test: 9:00 AM Cortisol<50.0 Post ACTH: 163 (inadequate response) MRI of pituitary: Pituitary atrophy. In view of his biochemical findings of Pan hypopituitarism he was commenced on oral hydrocortisone, levothyroxine and topical testosterone gel in replacement doses.

Conclusion and points for discussion: This case demonstrates the importance of considering late onset hypopituitarism in the patients who received radiotherapy for the tumours of the adjacent organs. In the central nervous system the Hypothalamus pituitary axis acts an importance unit which is sensitive to the effects of radiations and its exposure put these patients at great risk of developing hypopituitarism. The timely identification and management of this condition will help reducing the morbidity and mortality associated with this condition.