ECE2017 Eposter Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (145 abstracts)
Hypogonadotropic hypogonadism in a patient with long-term primary hypothyroidism
Raquel Vaz de Castro 1 , José Maria Aragüés 2 , Florbela Ferreira 1 , Vânia Gomes 1 , Ana Wessling 1 & Maria João Bugalho 1
1Santa Maria Hospital, Lisbon, Portugal; 2Beatriz Ângelo Hospital, Lisbon, Portugal.
Abstract: We report the case of a 65-year-old man who presented with erectile dysfunction to an appointment in our Endocrinology department. He referred fatigue, weight gain and constipation as secondary complaints that had been steadily evolving throughout the past 4 years. He denied other symptoms such as visual impairment or headaches as well as the consumption of any medications or drugs. His past medical history was unremarkable. On examination, BMI was 25.8 kg/m2, arterial blood pressure 112/64 mmHg, heart rate 71 BPM and temperature 36.4 °C. Neck palpation revealed a diffuse thyroid enlargement. Visual acuity and visual fields were unaltered. Blood tests revealed elevated TSH (69.8 uU/ml) with low FT4 (0.18 ng/dl), consistent with the diagnosis of primary hypothyroidism, and hypogonadotropic hypogonadism (testosterone 74.3 ng/dl). PRL levels were slightly elevated (38 ng/ml). Magnetic resonance imaging (MRI) of the pituitary showed a 17×14×12 mm sellar mass, without compression of the pituitary stalk or optic chiasm. The patient was started on levothyroxine 100 mcg per day. Three months later, the erectile dysfunction had resolved and thyroid function and total testosterone had returned to normal – TSH 0.90 uU/ml, FT4 1.16 ng/dl, and total testosterone 522.8 ng/dl. The control MRI taken one year after starting therapy revealed regression of the pituitary enlargement. This is a peculiar case of HH likely associated with pituitary hyperplasia, in the context of long standing primary hypothyroidism, successfully treated with levothyroxine.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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