Endocrine Abstracts

Introduction: Infundibulo - hypophisitis is a rare type neuroendocrine disorder characterized by autoimmune inflammation and various pituitary disfunction. It currently has no clear diagnosis criteria.We present the 26 years–old women, first diagnosed with infundibular neurohypophisitis with clinical Diabetes Insipidus and later with other metabolic disorders.

Case description: The patient, female, 26 years old came in the emergency room with extreme fatigue, weakness, alteration of the conscience and high fever. She was first diagnosed with Limfocitar Hypophysitis in 2017, secondary Diabetes Insipidus and pituitary hypothyroidism and was being treated with Desmopresin, Levothyroxine and Dexamethasone.At the moment of the presentation, she had the following parameters: Glicemia 1062 mg/dl, Urea 126 mg/dl, Creatinine 2.0 mg/dl, Na 155 mmol/l and K 3.6 mmol/l. HbA1C 9.4% Brain CT showed no acute cerebral damages. She was first hospitalized in Intensive Care Unit and later transferred in our Department as Secondary Diabetes Mellitus and hyperosmolar hyperglycemic state. During her stay, she complained of high fever and pain in both knees. She was diagnosed with Bilateral Pneumonia, Urinary tract infection and Tendinitis for which she was administered antibiotics and non steroid anti inflammatory drugs. Her blood glucose level was rapidly normalized and although she started insulin, after a few days she didn’t required anymore therapy with hypoglicemiant drugs. Dexamethasone was gradually substituted with hydrocortisone as morning blood cortisol was 0.25 ng/ml (55–230). Other parameters resulted as followed: Urinary density 1010, CRP 15.4 (1.1–8.0 ng/ml), Triglycerides 649 mg/dl and Cholesterol 336 mg/dl. A total body scan was done which resulted normal. When discharged, her parameters were stable and she was given therapy with hydrocortisone, levothyroxine, desmopresine and fibrate.

Conclusion: Infundibulo- Hypophysitis is a rare form of neurological disorder. It can show both local symptoms of inflammation and hormonal dysfunction, depending on the location and dimension of the lesion. Anti inflammatory treatment and partial or total hypopituatarism can create metabolic disorders which need a closer look and a careful follow up.