Dual Endocrinopathy - a Case Vignette

Wenhui Huang

doi:10.1530/endoabs.90.EP858

Initial Presentation (February 2018) A 54 years old Chinese male attended the Emergency Department of a public hospital in February 2018 for psychotic symptoms of 1-month duration. He has a past medical history of bifrontal craniotomy 20 years ago for brain tumour. A computed tomography scan of the head was performed which showed increased pituitary fossa and suprasellar space soft tissue. A pituitary hormone panel was performed [Table 1]. He was diagnosed with Grave’s disease and started on oral Carbimazole 5mg OM and given an Endocrinology outpatient appointment. Subsequent Follow Up (June 2018) He was seen in an Endocrinology outpatient clinic in June 2018 with the following blood test result [Table 2]. His Carbimazole was reduced from 5mg OM to 2.5mg OM. Another Emergency Department Attendance (October 2018) He attended the Emergency Department of another hospital in Oct 2018 for headache & giddiness. A thyroid panel was performed [Table 2]. Evolving central hypothyroidoism with panhypopituitarism was suspected. A short synacthen test and a repeat pituitary panel confirmed this. Magnetic resonance imaging of the brain subsequently confirmed the presence of a pituitary macroadenoma.

Table 1
Hormonal Test	Reference Range	Results [Feb 2018]
8am Cortisol
Adrenocorticotrophic Hormone (ACTH)	1.6-13.9pmol/l	404
Random Growth Hormone (GH)	<3.0 mg/l	0.07
Insulin-like Growth Factor 1 (IGF-1)	48-209 mg/l	<25
Follicle-Stimulating Hormone (FSH)	1.5-12.4 iu/l	0.8
Luteinizing Hormone (LH)	1.7-8.6 iu/l	0.1
Testosterone (bounded)	9.9-27.8 nmol/l	0.77
Thyroid Stimulating Hormone (TSH)	0.27-4.2 mIU/l	<0.005
Free Thyroxine (fT4)	12-22 pmol/l	24.1
TSH Receptor Antibody (TRAb)	<1.8 iu/l	3.5
Thyroid Peroxidase antibody (Anti-TPO)	5-34 iu/mL	175
Prolactin	86-324 mIU/l	808

Table 2
Hormonal Test	Reference Range		Results
		Feb 2018	June 2018	Oct 2018
8am Cortisol		404	404
Adrenocorticotrophic Hormone (ACTH)	1.6-13.9pmol/l	2.2	4.5
Random Growth Hormone (GH)	<3.0 mg/l	0.07	<0.05
Insulin-like Growth Factor 1 (IGF-1)	48-209 mg/l	<25	133
Follicle-Stimulating Hormone (FSH)	1.5-12.4 iu/l	0.8	0.8
Luteinizing Hormone (LH)	1.7-8.6 iu/l	0.1	0.1
Testosterone (bounded)	9.9-27.8 nmol/l	0.77	0.34
Thyroid Stimulating Hormone (TSH)	0.27-4.2 mIU/l	<0.005	0.160	2.61 [0.45-4.5]
Free Thyroxine (fT4)	12-22 pmol/l	24.1*	10.2*	5* [8-16]
TSH Receptor Antibody (TRAb)	<1.8 iu/l	3.5	-
Thyroid Peroxidase antibody (Anti-TPO)	5-34 iu/mL	175	-
Prolactin	86-324 mIU/l	808	790

Learning points

• This is a rare case of concurrent Grave’s Disease and panhypopituitarism

• Interim treatment with carbimazole further confounded interpretation of the thyroid panel trend

• Long term treatment is unpredictable and will require close monitoring

Endocrine Abstracts

EP858

Dual Endocrinopathy – a Case Vignette

Wenhui Huang

Volume 90

25th European Congress of Endocrinology

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