Endocrine Abstracts

Introduction: Spacious sellar area predisposes to late diagnosis of nonfunctional pituitary adenomas and in males even the functional ones such as prolactinomas. Rising prevalence of obesity is mainly associated with sedentary lifestyle and excess of food intake. Only in rare cases has endocrine etiology such as Cushing disease, hypothyroidism or hypothalamic disorders.

Case-report: A 29-year-old man was admitted to our hospital for chest pain, with a highly elevated cardiovascular troponin marker. Acute coronary syndrome was excluded on echocardiography and CT coronarography and he was treated for acute perimyocarditis. Under these stress conditions random thyroid hormones were measured: TSH 1.9 mIU/l [0.35–4.9], fT3 2.5 pmol/l [2.9–4.9], fT4 6.8 pmol/l [9–19], antithyroid antibodies negative and endocrinological follow-up was recommended. Regarding patient’s history – obesity since adolescence, currently BMI 38 kg/m², otherwise healthy. New findings covered the metabolic syndrome including dyslipidemia, arterial hypertension, and hyperuricemia. Laboratory findings after a month confirmed hypothyroidism of central etiology. Thyroid ultrasound was normal. The whole pituitary hormonal profile was screened, even though the patient was asymptomatic. Central hypogonadotropic hypogonadism and slight hyperprolactinemia were detected (LH 1.3 IU/l [1.7–3.6], FSH 1.7 IU/l [1.5–12.4], total testosterone 2 nmol/l [8.6–29], prolactin 30 mg/l [4–15]). Evident hypo- or hypercortisolism was not present (morning cortisol 298 nmol/l [166–507], ACTH 38.7 pmol/l [1.6–13.9], urinary cortisol 255 nmol/day [100–379]). Growth hormone and age-specific IGF-1 were in norm. Visual fields were intact, but the MRI scan detected sellar expansion (max. diameter 28 mm) with supra- and parasellar progression with an elevation of the optic chiasma. The patient with clinically nonfunctional sellar expansion was referred to neurosurgery for transsphenoidal tumor resection, histologically was confirmed pituitary adenoma with negative immunochemistry of pituitary hormones. Surgery and hormone replacement (currently levothyroxine and hydrocortisone) led to spontaneous BMI reduction to 36 kg/m². Testosterone is 4.5 nmol/l and as the patient is planning having a baby, spermiogram is now under investigation and the androgen replacement was postponed.

Conclusion: Nonfunctional pituitary macroadenomas can be found on the basis of diagnosed hypopituitarism, which can evolve slowly. The symptoms of local compression and expansion and symptoms of partial hypopituitarism appear discreetly and late. In case of obesity and dyslipidemia the evaluation of thyroid function can lead to surprising clinical findings as shows this case report.