Endocrine Abstracts

A 45 yr lady;presented with lethargy and tiredness, amenorrhea with 2 stone weight loss 3 months after delivery of her baby. Her thyroid functions were done showing low free T4 (0.28 mu/l) as well as low TSH (07 pmol/l). (Thought to be cooling off period of post-partum thyroiditis). She was started on Thyroid hormone replacement (levothyroxine 150 mg once a day) Reviewed again after a month in endocrine clinic, she still feeling tired, lethargic and unwell still not having periods. Repeat Thyroid Function Tests showed that she was over replaced, so thyroxine was stopped but on this occasion a full work up was done including complete pituitary profile. She was followed up again with pituitary functions results which showed a low Random Cortisol, followed by that she had a short synacthen test which confirmed adrenal insufficiency [Cortisol at 0 min= 170 ; 30 mins= 248; 60 mins= 267]. FSH 11.6, LH 3.1, estradiol >72. So, she was admitted to the hospital and was diagnosed with Panhypopituitriam and was commenced on Hydrocortisone and levothyroxine at a smaller dose 25 mcg. An MRI pituitary gland was also arranged for her, which showed bulky pituitary gland but no adenoma. She remained on steroid replacement and was subsequently followed up after couple of years, still having symptoms of tiredness, which were attributed to menopause. Her PTH levels were high with slightly low Calcium and normal Vit.D. She was treated as secondary hyperparathyroidismIn with Vit D and calcium replacement. Recently she presented with seizure like episodes and a low random cortisol again, but on this occasion her Short SynacthenTest was normal, so all her steroid therspy was stopped and a repeat MRI pituitary requested.

Conclusion: We should Consider Panhypopituitriam as a differential diagnosis in a patient presenting with postpartum thyroiditis.