Endocrine Abstracts

We report a 38 years old male who was referred to the endocrine clinic with 3 months history lethargy, lack of libido and reduced shaving frequency. He was previously fit and well with no past medical history however he and his wife has been trying for pregnancy for 2 years. He didn’t smoke, has no history of opioids use and drink 10 units of alcohol a week. His investigation showed panhypopiturism with profound low serum testosterone of <0.5 nmol/l (8.33–30.19), SHBG 33.2 nmol/l (13.5–71.4), lH <0.1 iu/l (0.57–12.07) FSH 0.6 iu/l (0.95–11.95), 0900 serum Cortisol of 51 nmol/l, TSH 1.12 miu/l (0.35–4.94), Free T4 5.9 pmol/l (9.0–19.0) and Insulin-like growth factor 1 9.9 nmol/l (8.3–29.2). MRI Pituitary gland showed 4 mm focus of subtly reduced enhancement in the left half of the pituitary fossa and 6 mm nodule infundibulum in keeping with neoplastic, infectious and granulomatous infiltration. CT Thorax abdomen showed extensive bilateral hilar and mediastinal lymphadenopathy with nodularity and fibrosis in the upper lobes which is typical of pulmonary sarcoidosis. Serum calcium was normal however serum Angiotensin converting Enzyme (ACE) came back elevated at 146 iu/l (10–75).

Diagnosis: Hypothalamic-Pituitary sarcoidosis and pulmonary sarcoidosis. He was started on Hydrocortisone, levothyroxine and topical testosterone as treatment for anterior pituitary dysfunction. His symptoms improved significantly. He has been referred to respiratory team for further evaluation and treatment of pulmonary sarcoidosis.

Discussion: Although patients with sarcoidosis have only 5% clinical involvement of the nervous system, the hypothalamus is the most frequently involved of all the endocrine glands. This case shows that in the absence of obvious systemic features of sarcoidosis, hypopituitarism was the index event leading to the diagnosis of a systemic disease. Treatment involves replacing hormones. Role of high dose systemic steroid to restore pituitary function is not established however there is some evidence of regression of radiological features.