Panhypopituitarism - a case with an unusual cause

Anish Basu; Shoaib Khan; Awadin Elhassan; Amy Glover; Ambar Basu

doi:10.1530/endoabs.109.EP27

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Endocrine Abstracts (2025) 109 EP27 | DOI: 10.1530/endoabs.109.EP27

SFEBES2025 ePoster Presentations Neuroendocrinology and Pituitary (6 abstracts)

Panhypopituitarism - a case with an unusual cause

Anish Basu ¹ , Shoaib Khan ² , Awadin Elhassan ² , Amy Glover ² & Ambar Basu ^2,3

Author affiliations

¹University College London, London, United Kingdom; ²Royal Bolton Hospital, Bolton, United Kingdom; ³University of Bolton, Bolton, United Kingdom

Introduction: This case outlines a rare cause of Pan-hypopituitarism in a patient with HIV on anti-retroviral treatment.

Case Study: A 74-year-old man of African-origin was diagnosed with HIV in 2002. He presented with Pneumocystis carinii pneumonia, low CD4 count, and high viral load. He was managed with anti-retrovirals leading to excellent response. Since 2002, he has been on various anti-retrovirals including Emtricitabine, Tenofovir, Efavirenz, Zidovudine, Abacavir, and Lamivudine. His thyroid functions became abnormal in June 2020, showing a reduction in Free Thyroxine (FT4) levels with inappropriately normal thyroid stimulating hormone (TSH) (Table 2). Further investigations showed low testosterone with normal gonadotrophins. The Synacthen stimulation test showed borderline normal results (Table 1).

Results: Testosterone – 6.4 nmol/l (8.7-29) Luteinising hormone (LH) – 4.0 u/L (1-10) Follicular Stimulating Hormone (FSH) – 5.0 u/L (1-8)

Synacthen Stimulation Test (Table 1)
Time (minutes)	0	30	60
Cortisol (nmol/l)	140	343	446
Adequate response either >420 at 30 minutes or > 430 at 60 minutes

Table 2.
Date	TSH (0.2-5 mu/l)	FT4 (10-24 pmol/l)
Dec-19	1.04	11.1
Aug-20	1.07	8.9
Apr-22	1.44	6.2
Mar-23	1.23	8.2
Jul-24	1.11	6.7
Magnetic Resonance Imaging of pituitary was normal.

Discussion: There is good evidence in literature pointing towards HIV disease process and anti-retrovirals being associated with pituitary and endocrine dysfunction in patient with HIV. HIV with high viral load can lead to hypopituitarism due to the immunosuppressant effect and hypophysitis. Anti-retrovirals can interfere with the hormone metabolism leading to hormonal abnormalities. As MRI pituitary was normal and there was no history of intracranial surgery, radiotherapy, injury, or apoplexy, we suspect the pituitary insufficiency is related to HIV.

Conclusion: Pituitary insufficiency in patients with HIV is unusual but recognized. The need for monitoring of pituitary hormones in HIV is not entirely clear and needs more research.