A 40 year old gentleman presented to his GP with a 12 month history of tiredness and breathlessness on playing basketball with his son. Initial investigations revealed he had a normocytic anaemia with haemoglobin of 9.8 and white cells and platelets were normal. He was referred to the Gastroenterologists and had normal renal function, liver function, bone profile, ESR and serum electrophoresis. His B12, folate and ferritin were normal. CT Abdomen was normal and duodenal biopsy did not reveal celiac disease. He was then referred to the haematologists and a bone marrow showed greatly reduced cellularity in keeping with a hypo plastic anaemia, with no evidence of malignancy. Further blood tests revealed a low testosterone of 3.3 nmol/l  and at this point he was referred to the Endocrinology team. Examination showed male pattern baldness, no gynaecomastia, normal external genitalia, both testis measuring 20 mls in volume and visual fields were normal. Chromosomal analysis was normal. Investigations revealed hypogonadotrophic hypogonadism [FSH=2.4 U/l, LH=1.4 U/l], free T4 of 7.4 pmol/l, Prolactin of 578 and serum IGF-1 of 32 nmol/l . Synacthen test at 0 and 60 minutes were 19 and 273 respectively. MRI Pituitary showed a large pituitary tumour extending in the suprasellar cistern and distorting the optic chiasm. Visual field tests were normal. He was started on hydrocortisone, thyroxine and testogel replacement. He has had a transsphenoidal hypophysectomy followed by radiotherapy. His anaemia has since improved and is now off erythropoietin.
Anaemia as a presenting feature of hypopituitarism is rare and there are only few reported cases in literature. However in diagnosed cases of hypopituitarism, anaemia is common [1020%]. It is usually normocytic normochromic. Leucocytopenia, thrombocytopenia and pancytopenia have been reported. Thyroid hormones and androgens are considered most important. We also discuss the role of Growth Hormone and Steroid hormones on erythropoiesis.
Hypogonadism in men due to a pituitary tumour is a potential cause of normocytic anaemia and should be considered in the differential diagnosis.
06 - 07 Nov 2006
Society for Endocrinology