Endocrine Abstracts

We report a case of 48 years old female with history of arterial hypertension and breast cancer in long term remission. She was admitted to the hospital due to strong headache. MRI of the brain revealed spontaneous intracranial hypotension caused by the cerebrospinal fluid (CSF) leak in left fronto-parietal region, thickening of pachymeningeal tissues, distension of sinus transvs and cranial buldging of the pituitary gland with non homogenous structure. Although patient did not present any clinical symptoms suspicious for hypopituitarism, the hormonal profile was performed and the central hypothyroidism was found (TSH less then 0.005 mIU/l; n=0.3-4.2 mIU/l, fT3 4.06 pmol/l; n= 3.1-6.8 pmol/l, fT4 11.02 pmol/l; n= 11.9 – 21.6 pmol/l), while all other axes were intact. Thyroid hormones were mildly decreased, therefore no substituion therapy was indicated. Patient underwent the procedure using epidural blood patch, with excellent clinical outcomes, CSF leak disappeared right after procodure. Hormonal tests one month after procedure found mild improvement of central hypothyroidism (TSH 0.03 mIU/l, fT3 4.6 pmol/l, fT4 11.2 pmol/l), other axes remained normal. Three months after procedure the MRI check up revealed complete resolution of the signs of intracranial hypotension, also pituitary gland turned to be homogenous and not enlarged. Laboratory tests shown normalization of thyroidal axis function (TSH 2.1 mIU/l, fT3 4.9 pmol/l, fT4 14.6 pmol/l). This case presents a rare cause of transient central hypothyroidism due to a spontanoues intracranial hypotension. To the best of our knowledge, only few cases of hypopituitarism in patients with this rare condition have been described to the date.