Endocrine Abstracts

A 34 year old male, previously healthy nightclub doorman presented with 2 years of reduced libido, fatigue, hot flushes and reduced beard growth. He had fathered three healthy children. He admitted to previous use of veterinary anabolic steroids up until 2 years ago. He had normal secondary sexual characteristics, no features of pituitary hypersecretion, normal visual fields but reduced testicular volumes (8 ml).

Biochemical investigation showed growth hormone, gonadotrophin and corticotrophin deficiency. Serum prolactin and thyrotrophin reserve were normal. Urinary screening for anabolic steroids was negative. Treatment with Hydrocortisone and subsequently testosterone was commenced. Magnetic resonance imaging showed a 15 mm lesion (hyperintense on T2 weighted studies) arising from the hypothalamic region. Biopsy demonstrated a pituicytoma with positive staining for S100 and Epithelial Membrane Antigen. Unfortunately, the patient died as a result of haemorrhage from the tumour after the biopsy.

This case demonstrates the importance of undertaking full assessment of pituitary function in hypogonadal patients, even when there is an apparently obvious cause. Subsequent imaging and biopsy revealed an unusual type of hypothalamic-pituitary tumour.

Some anabolic steroids can be extremely long acting, particularly those normally used in veterinary practice. This may confound accurate diagnosis. Anabolic steroids have been reported to be mitogenic in both human and animal models. Affected tissues include bone, bone marrow, pancreas and liver. There is some evidence that this may be mediated through the androgen receptor and induction of growth factors. We were unable to find previous reports of pituitary or other intracranial tumours in association with anabolic steroid use.