Endocrine Abstracts

We report on a 50-year-old patient of Moroccan origin, with insulin treated type 2 diabetes known for several years. He presented with a 6 months history of hypoglycemia, hypotension, associated with loss of libido and erectile dysfunction, anorexia, general deterioration and weakness. He had lost 20 kg over a 6-month period. The insulin doses were diminished from 70 to 42 U/day and the antihypertensive treatment was stopped due to repeated episodes of hypotension.

Laboratory results showed reduced free thyroxin with normal TSH and diminished morning serum cortisol levels. Besides, testosterone, LH and IGF1 levels were also reduced. The pituitary stimulation tests (TRH, LHRH, insulin induced hypoglycemia) revealed a delayed response in TSH, a delayed and prolonged response in LH, and no response in ACTH and GH. A MRI of the sella turcica revealed a macro adenoma with a left deviation of the pituitary stalk and a minimal compression of optical chiasma.

Findings were consistent with panhypopituitarism due to a pituitary adenoma. A replacement therapy was started including hydrocortisone, L-thyroxine and testosterone. Accordingly, symptomatology improved. The patient was then treated by endoscopic endonasal transsphenoidal adenomectomy leaving small amounts of healthy pituitary tissue. Immunohistology showed α-subunit positive cells.

Hypoglycemia and erectile dysfunction in a diabetic patient should not overlook other causes than excessive treatment and diabetes.

Keywords: Hypoglycemia, diabetes, erectile dysfunction, panhypopituitarism