Endocrine Abstracts

Introduction: Hypophysitis is a rare association of inflammatory bowel disease (IBD) with only few cases reported in the literature. It can present with isolated hormone deficiencies or panhypopituitarism. Patients may also present with symptoms secondary to inflammatory pituitary mass. Management consists of hormone replacement therapy, but high dose steroids, steroid sparing agents like Rituximab or even surgery may be required for mass effect.

Case report: A 28-year-old gentleman with 8 years history of Crohn’s disease treated with 8 weekly intravenous Infliximab presented with rapid onset of unquenchable thirst, polydipsia and polyuria (300 ml/h) interfering with work and quality of life. Eight months prior to presentation, he had enrolled in a trial to switch to subcutaneous Infliximab. Despite significant polydipsia of almost 10 L/24h and number of contacts with IBD team and GP, his referral to endocrinology was delayed. At his endocrine review, he was exhausted, dehydrated, unable to work and desperate for treatment. His sodium was 144 mmol/l (133-146) despite 10L daily fluid intake, glucose and calcium were normal. There was no recent oral steroid treatment for IBD. Apart from IV to SC Infliximab delivery change, there was no other change in therapy. Anterior pituitary hormones were normal. ESR was raised at 80 mm/h despite no change in bowel symptoms. Pituitary MRI showed slightly thickened pituitary infundibulum. Due to significant symptoms, desmopressin was commenced without delay, with fantastic response.

Conclusion: This case reminds us of the association between granulomatous diseases like Crohn’s disease and hypophysitis, which can also occur in context of concurrent treatment with biologic therapies such as infliximab. There were only subtle findings on MRI scan in this case and high dose oral steroids were not required. Awareness of this association in patient with IBD by non-specialists can ensure rapid access to treatment.