A BOY WITH UNTREATED PANHYPOPITUITARISM

CASE REPORT

Abstract

INTRODUCTION/BACKGROUND
Hypopituitarism in childhood is a complex disorder with diverse clinical presentation which can either be congenital or acquired. Hormonal deficits can evolve over time leading to a significant impact on a child’s growth. We describe a case of untreated panhypopituitarism presenting as an adrenal crisis managed in a district hospital.

CASE
A 13-year-old Indonesian male with a background of panhypopituitarism post mature teratoma resection in January 2020 presented an adrenal crisis after he defaulted treatment for 2 years. On presentation, he had hypoglycaemia with shock requiring extensive fluid resuscitation and double inotropic support. Examination revealed weight and height below 3rd centile, pre-pubertal with thin eyebrows and depressed tendon reflexes. Height velocity was 4.2 cm/year for past 2 years. His random cortisol was extremely low (<1.5 nmol/L) with hypothyroidism. Intravenous stress dose hydrocortisone was initiated and his hemodynamic status improved over time. Oral thyroxine supplement was restarted and he required regular dose of sublingual desmopressin for diabetes insipidus.

CONCLUSION
Untreated panhypopituitarism has been reported in adult as late as 45 years old with significant impairment in cardiac function, growth and regression of sexual characteristic. With appropriate hormonal replacement, growth can be optimized and lifetime expectancy can be improved without long term sequelae.