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Cureus Aug 2023Sarcoidosis is an inflammatory condition that can impact multiple organs in the body such as the lungs, skin, eyes, and, occasionally, the central nervous system. When...
Sarcoidosis is an inflammatory condition that can impact multiple organs in the body such as the lungs, skin, eyes, and, occasionally, the central nervous system. When sarcoidosis affects the nervous system, it is referred to as neurosarcoidosis and is estimated to occur in approximately 5%-15% of sarcoid patients. When neurosarcoidosis affects the pituitary gland, it can result in panhypopituitarism, which can be life-threatening. A 35-year-old male with a known diagnosis of sarcoidosis by skin biopsies presented to the hospital with altered mental status, hypernatremia, hypotension, and hypothermia. He reported symptoms of polyuria and polydipsia for several weeks before admission. Laboratory workup revealed elevated serum sodium at 167 mmol/L, high serum osmolality at 381 mOsm/kg, and low urine osmolality at 381 mOsm/kg, consistent with diabetes insipidus. Anterior pituitary hormone profile workup revealed low 8 am serum cortisol (1.9 mcg/dL) and inappropriately normal adrenocorticotropic hormone (ACTH) (34 pg/ml), low serum free testosterone (<2.5 ng/dL), low luteinizing hormone (0.7 mIU/ml), low follicular stimulating hormone (< 2.6 mIU/ml), low free T4 at 0.4 ng/dL. and inappropriately normal thyroid-stimulating hormone (TSH) at 2.77 uIU/mL. Serum prolactin was mildly elevated at 86.8 ng/mL. Angiotensin-converting enzyme level was within the normal range at 33 U/L. A diagnosis of panhypopituitarism was made. Brain MRI revealed a 3 cm mass in the suprasellar region involving the hypothalamus and bilateral optic tracts with a mass effect on the anterior third ventricle. No discrete pituitary or stalk lesion was identified. A ventriculostomy tube was placed for developing hydrocephalus. A biopsy of the suprasellar mass revealed non-caseating granuloma, confirming neurosarcoidosis. Treatment was initiated with high-dose IV corticosteroids to manage secondary adrenal insufficiency and neurosarcoidosis. He was also started on IV desmopressin and IV levothyroxine to manage his diabetes insipidus and central hypothyroidism. He was transitioned to oral therapy upon discharge. Panhypopituitarism secondary to neurosarcoidosis is a rare presentation that can occur due to the infiltration of the pituitary gland or the infiltration of the hypothalamus affecting the hypothalamic-pituitary axis. Neurosarcoidosis should be considered a differential when evaluating patients with symptoms consistent with panhypopituitarism. Prompt diagnosis and initiation of corticosteroids and deficient hormones can be lifesaving.
PubMed: 37692696
DOI: 10.7759/cureus.43169 -
Journal of the ASEAN Federation of... 2023
Topics: Humans; Uvula; Cleft Palate; Hypopituitarism
PubMed: 37252424
DOI: 10.15605/jafes.038.01.18 -
Journal of Pediatric Endocrinology &... Sep 2019Background Neurosarcoidosis is not a common entity from an endocrinology standpoint. Prompt diagnosis is essential in order to determine appropriate treatment and to... (Review)
Review
Background Neurosarcoidosis is not a common entity from an endocrinology standpoint. Prompt diagnosis is essential in order to determine appropriate treatment and to establish prognosis. Case presentation Our case illustrates the difficulties encountered in making a diagnosis of sarcoidosis in an adolescent who presented with polyuria, polydipsia and hypernatremia. She developed panhypopituitarism and her deficits did not improve after treatment. Conclusion Pediatric endocrinologists diagnose and treat panhypopituitarism associated with many conditions. Neurosarcoidosis should be considered as part of the diagnosis in patients with panhypopituitarism, especially if there is evidence of multi organ disease. Case reports can effectively address the gap in knowledge due to the limited exposure of physicians to this field, especially in children.
Topics: Adolescent; Central Nervous System Diseases; Female; Humans; Hypopituitarism; Prognosis; Sarcoidosis
PubMed: 31343982
DOI: 10.1515/jpem-2019-0110 -
Internal Medicine (Tokyo, Japan) Feb 2023A 59-year-old man suspected of having myocardial infarction with sinus bradycardia, a decreased blood pressure, and ST-change on an electrocardiogram was referred to our...
A 59-year-old man suspected of having myocardial infarction with sinus bradycardia, a decreased blood pressure, and ST-change on an electrocardiogram was referred to our hospital's emergency department. Emergent coronary angiography revealed no significant findings. However, the patient experienced shock and required intensive care. Curiosity rose when his urination volume was not disturbed; we suspected hormonal abnormalities. A hormonal examination and imaging analysis revealed panhypopituitarism caused by a Rathke's cyst. Appropriate hormonal replacement therapy improved his symptoms and led to normalization of his electrocardiogram findings. Acute coronary syndrome (ACS) is a fatal disease; however, clinicians must not discount panhypopituitarism, as it may mimic ACS symptoms.
Topics: Male; Humans; Middle Aged; Acute Coronary Syndrome; Hypopituitarism; Cysts; Emergency Service, Hospital
PubMed: 35705269
DOI: 10.2169/internalmedicine.0031-22 -
Annals of African Medicine 2021While hypopituitarism is known to be associated with increased cardiovascular morbidity and mortality, panhypopituitarism as a complication of myocardial infarction (MI)...
While hypopituitarism is known to be associated with increased cardiovascular morbidity and mortality, panhypopituitarism as a complication of myocardial infarction (MI) is very rare. Here, we report a case of rapidly developing empty sella syndrome with florid manifestations of panhypopituitarism after MI (due to critical stenosis in the left anterior descending artery) complicated by cardiogenic shock in a 65-year-old man. The patient was initially stabilized with conservative management of non-ST-elevated MI and cardiogenic shock, but after initial improvement, he again deteriorated with refractory shock (not adequately responding to vasopressors), seizures, hypoglycemia, hyponatremia, hyperkalemia, and metabolic acidosis. After ruling out recurrent cardiogenic shock or other causes of refractory hypotension, panhypopituitarism was diagnosed with the help of hormonal assays and imaging. With no prior evidence of hypopituitarism, we suspect that panhypopituitarism developed due to acute pituitary apoplexy secondary to initial cardiogenic shock. The patient was successfully survived by the emergency endocrine management followed by secondary coronary angioplasty.
Topics: Aged; Heart Failure; Humans; Hypopituitarism; Male; Myocardial Infarction
PubMed: 34213484
DOI: 10.4103/aam.aam_66_19 -
Ugeskrift For Laeger Jun 1963
Topics: Adrenocorticotropic Hormone; Hypopituitarism; Testosterone; Thyronines
PubMed: 14024941
DOI: No ID Found -
JAAD Case Reports Sep 2023
PubMed: 37680570
DOI: 10.1016/j.jdcr.2023.07.003 -
Clinical Case Reports Dec 2019Panhypopituitarism secondary to Neurosarcoidosis is a rare however serious complication. This diagnosis should remain in the differential in patients with...
Panhypopituitarism secondary to Neurosarcoidosis is a rare however serious complication. This diagnosis should remain in the differential in patients with hypothalamic-pituitary dysfunction. Biopsy of lesions will give definitive diagnosis.
PubMed: 31893082
DOI: 10.1002/ccr3.2521 -
Cureus Jul 2020Hypopituitarism is a rare disorder. Hypopituitarism can present as a deficiency of individual anterior pituitary hormones (e.g., adrenocorticotropic hormone,...
Hypopituitarism is a rare disorder. Hypopituitarism can present as a deficiency of individual anterior pituitary hormones (e.g., adrenocorticotropic hormone, thyroid-stimulating hormone, luteinizing hormone, follicle-stimulating hormone, prolactin, growth hormone) or posterior pituitary hormones (e.g., oxytocin, vasopressin) or as the deficiency of all these pituitary hormones, also known as panhypopituitarism. Here, we discuss a 59-year-old man who presented with two episodes of unwitnessed syncope after an episode of vomiting. On admission, the patient was hypotensive to 88/54 mmHg, afebrile, and with a leukocyte count of 21.43 K/µL (reference range: 3.80 to 10.50 K/µL). CT scan of the head revealed a hyperdensity in the left intracranial internal carotid artery just proximal to the bifurcation, suggesting an artifact or presence of an embolus. Additional findings included a sellar mass with calcifications and suprasellar extensions. The patient was admitted for further workup of syncope. Other differential diagnoses included sepsis, stroke, cardiac arrhythmias, and pulmonary embolism. Sepsis, stroke, and cardiac workup were negative for significant findings. The patient remained persistently hypotensive despite aggressive intravenous hydration, raising suspicion for an underlying endocrine disorder. MRI of the brain was negative for stroke but again was significant for a sellar mass. Additional workup showed a deficiency of all the anterior pituitary hormones likely secondary to mass effect. The patient was diagnosed with panhypopituitarism due to pituitary macroadenoma.
PubMed: 32789047
DOI: 10.7759/cureus.9102 -
Proceedings (Baylor University. Medical... 2022Panhypopituitarism is an extremely rare disorder in acute myeloid leukemia (AML). To our knowledge, only six cases have been reported. Of note, central diabetes...
Panhypopituitarism is an extremely rare disorder in acute myeloid leukemia (AML). To our knowledge, only six cases have been reported. Of note, central diabetes insipidus is known to be associated with AML in patients with certain cytogenic abnormalities, such as monosomy chromosome 7 and inv(3)(q21;q26). We describe a 30-year-old incarcerated woman with newly diagnosed AML who developed panhypopituitarism. Her cytogenetic studies revealed a normal karyotype, were negative for inv(3)(q21;q26), but were positive for FMS-like tyrosine kinase 3 internal tandem duplication.
PubMed: 36304602
DOI: 10.1080/08998280.2022.2093589