Endocrine Abstracts

JOINT1931

56-year-old male patient visited his doctor as an outpatient with fatigue and chest complaints. Acute coronary syndrome was excluded. 3 weeks later, the patient voluntarily presented to the psychiatric clinic, from where he was immediately admitted to the ward for sleep disturbance and psychomotor slowing. On admission, hypotension, elevated cardiac necro enzymes, proBNP values and hyponatraemia were seen despite continuous Na supplementation. Low sodium levels despite sodium supplementation, the patient was referred to the endocrinology department for investigation of suspected hypoadrenia. His hormone profile confirmed panhypopituitarism, underlying cranial imaging confirmed a 9x12.5x10 mm pituitary macroadenoma, no neurosurgical intervention was performed. Despite adequate hormone replacement, no improvement was seen in the patient’s condition, and the clinical picture was still characterised by a high degree of weakness and anaemia. Gastroscopy and biopsy raised the possibility of amyloidosis. Subsequently, the patient was referred to the cardiology department, where cardiac MRI confirmed the diagnosis of cardiac amyloidosis. Serum immunoelectrophoresis was performed due to elevated kappa light chain values and bone marrow biopsy was performed, which revealed the presence of multiple myeloma, and AL amyloidosis was described in the heart. Recovery from heart failure therapy was initiated, he developed another hypotensive crisis, Staphylococcus aureus infection, sepsis, resulting in patient’s death. The picture of hypothyroidism as part of panhypopituitarism showed similar similar clinical symptoms to AL amyloidosis. Despite hormone replacement, the patient’s life could not be saved due to the severe co-morbidity, AL amyloidosis and consequent heart failure.