Endocrine Abstracts

Negative caloric balance and low body weight can impair pituitary function. This syndrome is well recognised in women, but it is less often diagnosed or considered in men. We present the case of a 16-year-old male who presented with increasing tiredness, bloating and inability to focus over a period of 3 months. He had been involved in regular sporting activities over last few years recently increased the physical activity focusing on fitness with a calorie deficit diet leading to significant weight loss over a period of 3 to 4 months. He had a normal childhood and satisfactorily achieved all his developmental milestones. He entered puberty at approximately 12 years of age and developed normal male secondary sexual characteristics with normal sexual functions. He was 180 cm tall and 55.25 kg initially with a Body Mass Index at the 6th centile for his age. On examination, he had Tanner stage 5 sexual development, fully descended testicles bilaterally which were soft, 15ml in volume. He shaved regularly and noticed no change in his body or facial hair volume. His had normal sense of smell. His initial pituitary profile showed pituitary dysfunction and is summarised in table 1. His pituitary MRI was normal and baseline investigations ruled out chronic illness. His DEXA scan showed normal bone density and Vitamin D levels were satisfactory. He was given advice to reduce his exercise down to maximum 150 to 200min moderate physical activity per week and increase his caloric intake with the assistance of a dietician. He also commenced 50 micrograms of levothyroxine. His weight was carefully monitored, and this has improved gradually up to 76 kg over the next 8 months with recovery of pituitary function. The pituitary profile changes are summarised in table 1. This case highlights how hypopituitarism should be considered as a cause of fatigue in male athletes and recovery of hypothalamic pituitary axis following appropriate dietary and lifestyle modifications.