Endocrine Abstracts

42 years old male referred to endocrinology for the symptoms of joint pains, lethargy, sweating and low testosterone levels. Medical history was consistent with obstructive sleep apnea established on CPAP machine. On examination high BMI, prominent lower jaw, and large hands were noted. Investigations confirmed raised IGF-1: 550 ng/ml (normal range 101-267), Low baseline cortisol 126 nmol/l, Low testosterone: 3.1 nmol/l, low LH:2 IU/l/FSH:1IU/l with normal thyroid function test TSH:2.98 mU/l, T4:12.4 pmol/l. GH Day curve suggested mean growth hormone 0.97 mg/l. MRI pituitary suggested Left microadenoma 0.9 mm confined to within the gland. Hormone axis was further assessed with oral glucose tolerance test which indicated nadir Growth hormone 0.9 mg/l. Insulin tolerance test showed peak Cortisol of 555 nmol/l. Testostrone replacement commenced and was referred to surgeons after discussing in Pituitary MDT. In view of low baseline cortisol, he was initiated on hydrocortisone 10 mg/5 mg/5 mg. He underwent Transsphenoidal resection and the histology was consistent with densely granulated somatotroph. Post operatively IGF-1 were noted to be 232 ng/ml (69-208). Cortisol incremented to 529 nmol//l on Insulin tolerance test hence weaned off hydrocortisone. Post-surgery MRI Pituitary was normal. 6 monthly oral glucose tolerance tests were all <0.3 mg/l, indicating a very good result. Insulin tolerance test shows undetectable growth hormone levels with AGHDA score 23/25 Initiated on growth hormone replacement along with testosterone replacement.