Endocrine Abstracts

A 48 year old man was reviewed in the late endocrine effect of childhood cancer treatment clinic. He was diagnosed with Acute Lymphoblastic Leukemia back in 1983, at the age of 9 and underwent chemotherapy with UKALL X regime, craniospinal irradiation, followed by total body irradiation and autologous bone marrow transplant the same year. Subsequently he was found to be growth hormone deficient 2 years later and by the age of 21 he developed hypopituitarism. In 2001, by the age of 27, he was also diagnosed with Type 1 DM. He also had an impressive complex background of Dilated Cardiomyopathy secondary to anthracycline therapy, Pulmonary Fibrosis from Sarcoidosis, Recurrent strokes in childhood related to radiation vasculopathy, pancreatic exocrine insufficiency and SMART (Stroke-Like Migraine Attacks after Radiation Therapy) Syndrome. When he was seen in clinic in December 2022, he was on the following medications: Levothyroxine 100 mg OD, Nebido 1gr every 12 weeks and on an insulin pump for diabetes. His Growth Hormone (Subcutaneous Genotropin 0.1 mg OD) was ceased in February 2022 as it was felt that the latter could be contributing to his poor glycemic control and possible insulin resistance. Interestingly he was never on hydrocortisone as replacement as his HPA axis remained intact. He was requiring a substantial 300 Units of Insulin via the pump and even then, his blood glucose readings were off target. In clinic, he was mostly concerned about his erratic blood glucose readings and worsening exercise tolerance due to shortness of breath and fatigue. He had evidence of shaving on examination with obvious facial stubble. He reported having early morning erections and a good libido overall. He had his bloods checked on the same day and his endocrine panel was as follows: LH <0.1, FSH <0.1, Testosterone 28.8, TSH 1.16, FT4 15.5, IGF-1 20.2, Prolactin 173, PTH: 4.8, Adjusted Ca 2.52. Since his AGHDA score remained unchanged off the growth hormone injection (14/25) and in view of his poor glycemic control, the latter was not restarted and no changes were made to his medications since the rest of his blood tests were unremarkable. Given his persistent high insulin requirement for his diabetes, investigations and genetic tests were sent for possible insulin resistance syndrome.