Endocrine Abstracts

Introduction: Hypopituitarism is a rare entity that can have different aetiologies. Symptoms are usually progressive and non-specific; therefore, many patients are underdiagnosed and untreated. We present a clinical case of a patient presenting septic shock, hyponatremia and central hypothyroidism.

Case report: A 46-year-old man was admitted in ICU for septic shock of unknown origin and multiorgan failure. Hormonal profile showed central hypothyroidism, prolactin and gonadotropins deficiency. The integrity of corticotropic axis could not be assessed due to the immediate introduction of glucocorticoids, with a significant improvement in clinical status. An MRI was performed, which revealed increased dimensions of the sella turcica, with an apparent bone discontinuity of the sella turcica floor; it was not possible to visualize the right lobe of the adenohypophysis and the remaining pituitary gland had reduced dimensions. He was discharged home medicated with hydrocortisone and levothyroxine and was referred to Endocrinology outpatient clinic. He presented an history of previous traumatic brain injury (TBI) eighteen years earlier, requiring medical observation and an episode of intense headache with associated vomiting, eight years before when he started his complaints of asthenia, reduced libido, pale skin and decreased body hair began. Its fertility was unknown as he had no wish for procreation. Laboratory study control revealed panhypopituitarism: FSH 2.3 mIU/ml [< 15]; LH 0.7 mIU/ml [< 9.0]; 1.2 ng/ml prolactin [3.5-19.4]; Total Testosterone 0.1 ng/ml [2.7 - 11.0]; TSH 1.0 uUI/ml [0.4 - 4.0] Free T4 0.60 ng/dl [0.7 - 1.5]; ACTH 14 pg/ml [9-52]; Cortisol 0.4 mg/dl [5-25]; IGF1 22 ng/ml [53-215]. He was medicated with hydrocortisone 15 mg daily, levothyroxine 75μg/day and testosterone 250 mg IM every four weeks. At the time of the last observation, he reported a significant improvement in his general condition, normalized sexual activity and body hair growth.

Discussion: Discovering the cause of hypopituitarism can be a challenging. TBI can caused hypopituitarism several years after the event, and can even occur after minor trauma. The onset of symptoms of hypopituitarism after the episode of severe headache and vomiting also raises the possibility of another concomitant event, namely pituitary ischemia/haemorrhage. The hospitalization with septic shock, the detailed clinical evaluation and follow-up of the patient were crucial to detect the occurrence of this condition, associated with high morbidity and whose hormone replacement significantly improved the prognosis and quality of life.