Endocrine Abstracts

Background: Calcification or ossification of the auricular cartilage, known as "petrified ears," is a rare condition typically linked to local trauma, frostbite, or inflammation. Endocrinopathies, especially adrenal insufficiency, has been historically linked with this condition. There are several reports of its association with different causes of primary adrenal insufficiency but only a very few reported cases of secondary adrenal insufficiency leading to bilateral auricular calcification [1–4]. We are highlighting a case of hypopituitarism resulting in bilateral auricular calcification.

Case Report: This 31-year-old gentleman had a history of suprasellar germinoma diagnosed at the age of 15. He underwent surgery and radiotherapy in 2009 and developed panhypopituitarism soon afterwards treated with hydrocortisone, levothyroxine, testosterone and desmopressin. He was also on growth hormone replacement until his early adulthood. Over the last year, he started noticing both ears were getting hard and felt stony causing severe pain. He underwent a CT temporal bone which showed extensive calcification of both auricular cartilages. His adjusted calcium and phosphate levels were within normal range.

Discussion: The exact pathophysiological mechanism of hypocortisolism related calcification of the elastic cartilage remains uncertain. Barkan et al., previously have shown the association of hypopituitarism with auricle ossification and they proposed that the ossification was the result of endogenous cortisol deficiency [5]. Alteration in calcium homeostasis has also been suggested to contribute to ectopic calcification in cortisol deficiency, but calcium level was normal in our patient [6]. Bilateral involvement is more frequent than unilateral involvement, and petrified ears are more commonly encountered in males than in female [7].

Learning Points: 1. Petrified ears encountered in clinical practice without a clear aetiology should prompt consideration of possible undiagnosed endocrinopathies, especially adrenal insufficiency.