Endocrine Abstracts

Introduction: Radiation treatment is used for patients with secreting and non-secreting pituitary adenomas, residual pituitary adenomas, or recurrent pituitary adenomas to achieve long term disease control. The hypothalamic–pituitary unit is a particularly radiosensitive region in the central nervous system and pituitary hormone deficiencies are the commonest late complication of radiotherapy, which usually occur after several years. The development of hormone deficiencies with time varies in the published literature. We report a patient with hypopituitarism who developed clinical manifestations 2 years after radiation therapy.

Case Presentation: A 59-year-old man, who complained of general weakness and shortness of breath for the past 1-month, lost consciousness, had cardiac arrest. Ambulance was called, CPR was performed and the patient was transferred to the ICU of the hospital. There he was treated with infusion therapy, inotropic therapy, water-electrolyte balance treatment (KCl 4%), oxygen, insulin therapy, anticoagulants, gastroprotective therapy. Patient had a history of Lymphoblastic leukemia, which has been diagnosed 5 years ago, he underwent chemotherapy, radiation therapy and has been in remission for the past 2 years. He also had Type 2 Diabetes for 15 years, and was on insulin therapy for past 6 years. He had history of acute respiratory infection 1 month before current admission. On admission, examination revealed Ps=62 bpm, BP=106/65 mmHg, T=36.5⁰C, SpO₂ 95 % (7 liter/min O₂+), SpO2 80% (O₂-), BMI=33.6 kg /m². Daily diuresis 8000 ml, urine specific gravity-1005-1002-1004. Fasting glucose -10.4-9.8-6.8 mmol/l. Chest X-Ray, ECG and Echo were normal. Hormonal tests: LH-<0.100 mIU/ml (N 1.7-8.6), FSH- 0.457 mIU/ml (N 1.5-12.4), TSH-<0,009 uIU/ml (N 0.3-4.5), FT4-0,899 pg/ml (N 8.9-17.2), ACTH-2.14 pg/ml (7.2-63.3), Cortisol-21.89 nmol/l (171-586), Prolactin-4.07 ng/ml (4.6-21.4), Testosterone-<0.025 ng/ml (2.8-8), HbA1C -6.6% (4.8-5.9). Brain MRI was without features. He was diagnosed with Panhypopituitarism. Secondary hypocortisolism, Secondary hypothyroidism, Secondary hypogonadism, Central diabetes insipidus. Type 2 diabetes mellitus. The patient was given Oxygen, Infusion therapy, Levothyroxine 25 mg (2 days), then 50 mg (5 days) and 75/50 mg every other day, Hydrocortisone 10/5/10 mg 3 times daily, then 10/10/10 mg and 15/10/15 mg doses, Desmopressin at first 2 drops, then 3 drops daily. Dose adjustments were made with blood pressure, pulse and diuresis monitoring. The patient improved on treatment, he was discharged in good general health condition and was advised to continue hormonal therapy with the same doses and see endocrinologist regularly.

Conclusion: According to literature, clinical evaluation, baseline pituitary hormone assessment, and dynamic testing for growth hormone and adrenocorticotropic hormone (ACTH) deficiency (because they are the most sensitive) should begin one year after radiotherapy to prevent these life-threatening complications.