Years of Misery: a final resolution

Caoimhe Bonner; Bonnie Grant; Anna Hawkins; Yun-ni Lee; Augustine Williams; Sanjiv Chawda; Raj Tanday; Edel Casey; Khash Nikookam

doi:10.1530/endoabs.56.EP126

EP126

Prev Next

Section Contents Cite

Endocrine Abstracts (2018) 56 EP126 | DOI: 10.1530/endoabs.56.EP126

ECE2018 ePoster Presentations Pituitary and Neuroendocrinology (36 abstracts)

Years of Misery: a final resolution ‘panhypopituiatirsm’

Caoimhe Bonner ¹ , Bonnie Grant ² , Anna Hawkins ¹ , Yun-ni Lee ¹ , Augustine Williams ¹ , Sanjiv Chawda ¹ , Raj Tanday ¹ , Edel Casey ¹ & Khash Nikookam ¹

Err

Author affiliations

¹Barking Havering and Redbridge University Hospitals NHS Trust, Greater London, UK; ²Barking Havering and Redbridge NHS Hospitals Trust, Greater London, UK.

We report a case of a 76 year old gentleman referred to the endocrine department by his general practitioner (GP) with a few years history of severe lethargy, low mood, and dizziness on changing posture. He is known to have hypothyroidism, hypertension, hypercholesterolaemia, benign prostatic hypertrophy, and benign colonic polyps. His medications included amlodipine, finasteride, lansoprazole, atorvastatin and levothyroxine. Examination of all systems were unremarkable, in particular neurological examination with no postural drop. A full pituitary profile was performed which showed low free T4, cortisol, testosterone, and IGF-1, indicative of panhypopituitarism. A short synacthen test showed a serum cortisol at 0 and 60 minutes of 57 and 480 nmol/l respectively. He subsequently underwent an insulin tolerance test showing a drop in glucose from 4.8 to 2.0 mmol/l after 50 min, at which point the patient developed symptoms of dizziness and blurred vision. His blood glucose of 2.0 mmol/l was corrected to 4.2 mmol/l with two doses of glucojuice and 100 ml of 20% glucose infusion. A second drop in glucose was observed to 2.9 mmol/l which was corrected to 4.9 mmol/l with two further doses of glucojuice. The insulin tolerance test confirmed cortisol and growth hormone deficiency with flat cortisol and undetectable growth hormone levels. A computed tomography (CT) head scan was arranged instead of a magnetic resonance imaging (MRI) scan as the patient was claustrophobic, and did not reveal any pituitary abnormality. Following commencement of hydrocortisone he has felt much better and awaiting assessment for growth hormone and testosterone therapy.

Conclusion: It is paramount to consider endocrine dysfunction in patients with multitude/non-specific symptoms despite unremarkable clinical examination and normal basic pathological investigations.