ECE2023 Eposter Presentations Pituitary and Neuroendocrinology (234 abstracts)
Dual Endocrinopathy – a Case Vignette
Wenhui Huang
Tan Tock Seng Hospital, General Medicine, Singapore, Singapore
Initial Presentation (February 2018) A 54 years old Chinese male attended the Emergency Department of a public hospital in February 2018 for psychotic symptoms of 1-month duration. He has a past medical history of bifrontal craniotomy 20 years ago for brain tumour. A computed tomography scan of the head was performed which showed increased pituitary fossa and suprasellar space soft tissue. A pituitary hormone panel was performed [Table 1]. He was diagnosed with Grave’s disease and started on oral Carbimazole 5mg OM and given an Endocrinology outpatient appointment. Subsequent Follow Up (June 2018) He was seen in an Endocrinology outpatient clinic in June 2018 with the following blood test result [Table 2]. His Carbimazole was reduced from 5mg OM to 2.5mg OM. Another Emergency Department Attendance (October 2018) He attended the Emergency Department of another hospital in Oct 2018 for headache & giddiness. A thyroid panel was performed [Table 2]. Evolving central hypothyroidoism with panhypopituitarism was suspected. A short synacthen test and a repeat pituitary panel confirmed this. Magnetic resonance imaging of the brain subsequently confirmed the presence of a pituitary macroadenoma.
| Hormonal Test | Reference Range | Results [Feb 2018] |
| 8am Cortisol | ||
| Adrenocorticotrophic Hormone (ACTH) | 1.6-13.9pmol/l | 404 |
| Random Growth Hormone (GH) | <3.0 mg/l | 0.07 |
| Insulin-like Growth Factor 1 (IGF-1) | 48-209 mg/l | <25 |
| Follicle-Stimulating Hormone (FSH) | 1.5-12.4 iu/l | 0.8 |
| Luteinizing Hormone (LH) | 1.7-8.6 iu/l | 0.1 |
| Testosterone (bounded) | 9.9-27.8 nmol/l | 0.77 |
| Thyroid Stimulating Hormone (TSH) | 0.27-4.2 mIU/l | <0.005 |
| Free Thyroxine (fT4) | 12-22 pmol/l | 24.1 |
| TSH Receptor Antibody (TRAb) | <1.8 iu/l | 3.5 |
| Thyroid Peroxidase antibody (Anti-TPO) | 5-34 iu/mL | 175 |
| Prolactin | 86-324 mIU/l | 808 |
| Hormonal Test | Reference Range | Results | ||
| Feb 2018 | June 2018 | Oct 2018 | ||
| 8am Cortisol | 404 | 404 | ||
| Adrenocorticotrophic Hormone (ACTH) | 1.6-13.9pmol/l | 2.2 | 4.5 | |
| Random Growth Hormone (GH) | <3.0 mg/l | 0.07 | <0.05 | |
| Insulin-like Growth Factor 1 (IGF-1) | 48-209 mg/l | <25 | 133 | |
| Follicle-Stimulating Hormone (FSH) | 1.5-12.4 iu/l | 0.8 | 0.8 | |
| Luteinizing Hormone (LH) | 1.7-8.6 iu/l | 0.1 | 0.1 | |
| Testosterone (bounded) | 9.9-27.8 nmol/l | 0.77 | 0.34 | |
| Thyroid Stimulating Hormone (TSH) | 0.27-4.2 mIU/l | <0.005 | 0.160 | 2.61 [0.45-4.5] |
| Free Thyroxine (fT4) | 12-22 pmol/l | 24.1* | 10.2* | 5* [8-16] |
| TSH Receptor Antibody (TRAb) | <1.8 iu/l | 3.5 | - | |
| Thyroid Peroxidase antibody (Anti-TPO) | 5-34 iu/mL | 175 | - | |
| Prolactin | 86-324 mIU/l | 808 | 790 | |
Learning points
• This is a rare case of concurrent Grave’s Disease and panhypopituitarism
• Interim treatment with carbimazole further confounded interpretation of the thyroid panel trend
• Long term treatment is unpredictable and will require close monitoring
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Endocrine Abstracts
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