The integrity of bone marrow and its various haemopoeitic cells require several hormones including sex steroids. Sex steroids were used in the past to treat aplastic anaemia. A 27 years old Saudi male who underwent a resection of hypothalamic astrocytoma and developed panhypopituitarism was admitted to ICU with shunt related meningitis and noted to have thrombocytopenia of 90,000 anemia of 9.5 gldl, which progressed over the subsequent week following admission. He recovered from his meningitic illness uneventfully, however he remained with persistent thrombocytopenia and his platelet count dropped to a critical level but there was no bleeding diasthesis. He also remained anaemic and showed evidence of leucopenia. Full investigation for the cause didnt reveal any abnormalities, and a bone marrow biopsy showed hypoplastic bone marrow with megakaryocytic dysplasia. Checking the patient compliance with his medication in the past revealed that he never bothered to take sex hormone therapy since he has had his surgery at age 16 years, despite that the family claimed that he was taking thyroxin and hydrocortisone regularly. Daily testosterone decanrate 250 mg IM for 3 days was initiated which resulted in dramatic rise of platelet count to 430,000 and normalization of his leucocyte count Maintenance therapy with testosterone therapy every 3 weeks was initiated. Repeat bone marrow biopsy after 6 weeks of therapy showed normo- cellular marrow with disappearance of megakaryocyte dysplasia. This case highlights the importance of sex hormone replacement therapy in patients with hypopituitarism not only for sexual potency and sense of well being but also for integrity of bone marrow function.
01 - 05 Apr 2006
European Society of Endocrinology