Introduction: Hemochromatosis is an iron storage disease characterized by iron deposition in parenchymal cells due to increased intestinal iron absorption. Iron overload leads to tissue damage and dysfunction particularly in the liver, pancreas, heart, joints, and pituitary gland. Panhypopituitarism is a clinical condition in which the anterior pituitary gland hormones are deficient. Herein we report a very rare case of panhypopituitarism due to hemochromatosis.
Case: Sixty-two year old woman was admitted to a medical center because of hematemesis 6 years ago. An upper gastrointestinal Endoscopy revealed the presence of esophageal varices. Laboratory findings showed positive antibodies to HCV. 1.5 years ago performed liver biopsy established the presence of micronodular cirrhosis with accumulation of hemosiderin. Laboratory findings were as follows iron binding capacity: 120 μg/dl; Fe: 127 μg/dl; Ferritin: 581 ng/ml. Abdominal ultrasonography showed chronic liver parenchymal disease, splenomegaly (15.5 cm) and cholelitiazis. She hospitalized to the intensive care unit with the diagnosis of chronical liver parenchymal disease and hepatic encephalopathy, and therapy started. Her thyroidal function tests were as follows f-T4: 0.396 pg/ml, f-T3: <1 pg/ml, TSH: 0.795 IU/ml. We analysed other hypophysary hormon tests because we thought hypophysary involvement due to hemochromatosis. The values were LH: 1.12 IU/ml, FSH: 2.77 IU/ml, GH: <0.05 ng/ml, prolactin: 0.657 ng/ml, cortisol: 3.54 μg/dl. We performed ACTH stimulation test for hypophysary insufficiency (Synacten 1 mg IV). In 0 min cortisol level was 3.54 μg/dl, 30 min 20 μg/dl and 1 h 10 μg/dl. Therefore, we excluded primary adrenal insufficiency. The contrast hypophysary computerized tomography was normal. So we diagnosed the patient as panhypopituitarism. We administered prednisolon 40 mg initially and levothyroxin on the fifth day. She recovered with this therapy and discharged with prednisolone 7.5 mg/d. and levothyroxin 0.1 mg/d.
Discussion: Hemochromatosis may rarely cause panhypopituitarism by accumulation of hemosiderin. The clinician must be careful when a problem about conscious occurs in patients with cirrhosis due to hemochromatosis. Hepatic encephalopathy may confuse with panhypopituitarism. The differential diagnosis should be made otherwise the treatment might be delayed. In conclusion, the patients with hemochromatosis who have cirrhosis should be assessed about pituitary involvement.
03 - 07 May 2008
European Society of Endocrinology