Endocrine Abstracts

Panhypopituitarism refers to decreased production of all of the pituitary hormones of the adenohypophysis with or without deficiency of neurohypophysis function. The development of the disorder is frequently insidious and the manifestations often depend on the etiology of the condition.

Case report: In October 2019 a 57-year-old man collapsed in front of the hospital after being discharged from the cardiology clinic. The day before, he had undergone angiographic control for a bicoronary lesion treated in 2018 with Angioplasty with no evidence of restenosis or new lesions. After spontaneously recovering he described previous dizziness without chest pain or palpitations preceding the syncope. On physical examination presented with pale sweaty skin, absent facial hair, blood pressure 100/60 mmHg, heart rate 52/ min raising to 64/min under atropine. No evidence of hematoma, no changes on the EKG nor on the ultrasound, no arrhythmia or sinus pauses were detected on 24 h Holter. Blood sample showed a mild normochromic normocytic anemia and hyposodemia. Brain CT scan described an expansive intracranial process 36/43 mm axial and 33 mm cranio-caudal, with intense iodophilia, involving the right cavernous sinus with intra- and suprasellar extension, plated to the duramater of the large wing of the right sphenoid, invading the sphenoidal sinus, extending in plaque at the prepontin level and including the right: internal carotid artery, Meckel cavity, the orbit apex and right optic nerve. Re-interrogated, the patient declared having suffered several lipothymia episodes, for which a head MRI was performed on August 2018 describing the exact same lesion. Due to the extensions of the lesion the diagnosis of inoperable right cavernous sinus meningioma was reached.

The suspicion of Hypopituitarism is raised for the first time and he is referred for endocrinological exam. Lab results revealed: TSH = 3.97 uUI/ml (0.27–4.2), FT4 = 4.2 pmol/l (10.6–22.7), FSH = 1.8 mUI/ml (1.512), LH = 0.4 mUI/ml (1.7–8.6 mUI/ml), Testosteron = 2.50 ng/dl, 8 AM Plasma cortisol = 247.9 nmol/l (171–536 nmol/l), ACTH = 33.29 pg/ml, Prolactina = 555 uUI/ml (98–456), GH <0.05 ng/ml, IGF 1 = 68.6 ng/ml (81–225). Substitution treatment with prednisone and levothyroxine was initiated, with testosterone substitution being further considered.

Conclusions: Diagnosis and treatment of hypophysis insufficiency can sometimes be delayed. This case emphasises the importance of a thorough anamnesis and data integration in the investigation process. Screening of hypopituitarism in a defined risk populations may prevent under-diagnosis and reduce the severity, extent and duration of the condition.