Endocrine Abstracts

Adult-onset hypopituitarism is a frequently delayed diagnosis because of the insidious debut and non-specific symptoms, frequently attributed to normal aging or many other pathologies - fatigue, malaise, cognitive impairment, decreased libido. Left untreated, it can have severe consequences with vital impact.

Case-report: We present the case of a female patient, aged 69, who was initially addressed for evaluation of hypercalcemia. She had had four live births, last one at 38 years and she entered menopause at 54 years old. At the initial evaluation, the patient presented with hypercalcemia and elevated parathyroid hormone, as well as low fT4 and low TSH levels, suggesting secondary hypothyroidism along with primary hyperparathyroidism. Subsequent evaluations revealed also hypogonadotropic hypogonadism. The patient did not associate polyuric-polydipsic syndrome nor secondary adrenal insufficiency. The visual field evaluation was inconclusive due to cognitive impairment and difficult collaboration. There were no pathological changes in the pituitary area on contrast CT scan. She was started on levothyroxine therapy, with mild improvement in cognition. She will undergo DXA evaluation, parathyroid scintigraphy and surgery for hyperparathyroidism. She will remain under surveillance for developing adrenal insufficiency.

Conclusions: What seemed to be a simple case of primary hyperparathyroidism, turned out to be a surprisingly association between two endocrine diseases and a challenging diagnosis because fatigue, malaise and cognitive impairment are non-specific symptoms and could have been all attributed to hyperparathyroidism. Therefore, clinical and laboratory evaluation for hypopituitarism would be recommended in patient presenting with those subtle complaints.