Endocrine Abstracts

22 yr old male pt known case of ulcerative colitis and CVST, presented with diarrhoea, abdominal pain and left lower limb swelling. DVT was confirmed on doppler. During admission he suffered from UC flare up and developed toxic megacolon with perforation. An emergency laparotomy was performed, also an IVC filter was placed due to ongoing DVT. Medication history includes sertraline, clexane, fostair, adalimumab. During ITU admission, Pt was found to have increased urine output (>3l/24hr) post op., ongoing hypoglycaemia (bm< 3) and hypotension and required ionotropic support. He was receiving continuous IV dextrose (5 – 6 litres) daily. Blood work showed Serum osmolality=342, Urine osmolality=484 mOsmol/Kg, Urine Na <20 mmol/l. Na dropped from 159 to145 mmol/l was noted (after switching noradrenaline to vasopressin trial and stopped due to sudden drop). Initial blood test showed Sodium levels varying between 150-159 with normal potassium. Random cortisol 203 done at midnight. C peptide > 1000, Adj calcium- 2.42. Endocrinology review suggested full pituitary profile, MRI pituitary and short synacthen test. SST showed normal response. ACTH<1.5, IGF1 14.9, 9AM Testosterone levels were low at 0.4, TSH, FSH, LH and prolactin were normal. MRI showed the pituitary is small volume for patient’s age. No adenoma. Diagnosis of Pan-hypopituitarism secondary to extensive CVST, with dominant posterior pituitary symptoms was made after MDT discussion. He was commenced on IV hydrocortisone as ACTH being <1.5 confirms secondary adrenal suppression. Desmopressin was started at 100 mg TDS. Diazoxide 5 mg/kg daily in 2-3 divided dose as per response for intractable hypoglycaemia. Testosterone replacement in the form of Testogel starting from 40.5 mg OD. Due to intractable hypoglycemia and borderline low IGF-1 pt had glucagon stimulation test and that confirmed insufficient GH and was started on GH to improve hypoglycaemia. It was noted that patient did not receive any check point inhibitor for his treatment of Ulcerative colitis since his diagnosis.