PRIMARY HYPOPHYSITIS WITH HYPOPITUITARISM IMPROVING WITH HIGH DOSE STEROIDS

Authors

  • Xin-Yi Ooi Medical Department Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia
  • LL Lim Medical Department University Malaya Medical Centre, Malaysia
  • QH Lim Medical Department University Malaya Medical Centre, Malaysia
  • SR DB Vethakkan Medical Department University Malaya Medical Centre, Malaysia
  • J Ratnasingam Medical Department University Malaya Medical Centre, Malaysia
  • L Ibrahim Medical Department University Malaya Medical Centre, Malaysia
  • SS Paramasivam Medical Department University Malaya Medical Centre, Malaysia

DOI:

https://doi.org/10.15605/jafes.036.S46

Keywords:

hypophysitis, hypopituitarism

Abstract

INTRODUCTION
A 39-year-old female presented with an 8-month history of severe headaches, amenorrhea for 6 months, increased thirst and weight loss. She consulted a neurologist for migraine and was subsequently referred to an endocrinologist when her MRI showed a pituitary lesion. There was no visual impairment.

RESULTS
Investigations on admission:
Free T4 11.7 pmol/L (11.5-22.7)
TSH 0.11 mIU/L (0.55-4.78)
IGF-1 267 ng/ml (63.4-223)
ACTH <5 pg/ml
AM cortisol <14 nmol/L
LH <0.1IU/L(0.5-16.9)
FSH 2.8IU/L (1.5-9.1)
Estradiol 75 pmol/L (205-786)
Prolactin 511 mIU/L (59-619)

MRI of the pituitary gland showed a clearly thickened pituitary stalk abutting the optic chiasm with heterogeneous enhancement along the stalk and base of the hypothalamus and loss of posterior bright spot. The pituitary enhances peripherally with a slight hyperintensity on T1-weighted images, signifying proteinaceous or inflammatory changes. There was no dural tail sign. She was diagnosed with hypophysitis and was started on IV methylprednisolone 500 mg OD for 3 days. She developed overt polyuria after initiation of steroids and required regular desmopressin. As she is young with hypopituitarism and diabetes insipidus, she was given prednisolone 50 mg OD as per the protocol from Chiloco et al from Rome with a tapering dose planned over 13 months. In the study by Chiloco et al, this regime showed a 50-70% improvement in hormonal deficiencies compared to conservative treatment. This patient had resumption of her menses after 3 months despite still requiring regular desmopressin. There was improvement in her pituitary function with FT4 16.1 pmol/L, TSH 0.55mIU/L, LH 2IU/L, FSH 2.2IU/L and estradiol 193 pmol/L. Repeat MRI showed marked reduction in her stalk thickening.

CONCLUSION
High dose and prolonged steroids are an effective treatment to improve hormonal outcome in a patient with primary hypophysitis

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Author Biographies

Xin-Yi Ooi, Medical Department Hospital Kuala Lumpur, Wilayah Persekutuan, Malaysia

Endocrine Unit

LL Lim, Medical Department University Malaya Medical Centre, Malaysia

Endocrine Unit

QH Lim, Medical Department University Malaya Medical Centre, Malaysia

Endocrine Unit

SR DB Vethakkan, Medical Department University Malaya Medical Centre, Malaysia

Endocrine Unit

J Ratnasingam, Medical Department University Malaya Medical Centre, Malaysia

Endocrine Unit

L Ibrahim, Medical Department University Malaya Medical Centre, Malaysia

Endocrine Unit

SS Paramasivam, Medical Department University Malaya Medical Centre, Malaysia

Endocrine Unit

References

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Published

2021-07-28

How to Cite

Ooi, X.-Y. ., Lim, L. ., Lim, Q. ., Vethakkan, S. D., Ratnasingam, J. ., Ibrahim, L. ., & Paramasivam, S. (2021). PRIMARY HYPOPHYSITIS WITH HYPOPITUITARISM IMPROVING WITH HIGH DOSE STEROIDS. Journal of the ASEAN Federation of Endocrine Societies, 36, 36–37. https://doi.org/10.15605/jafes.036.S46

Issue

Section

Abstracts for Poster Presentation | Adult

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