Endocrine Abstracts

JOINT2465

Introduction: Internationally, panhypopituitarism has an estimated incidence of 4.2 cases per 100,000 per year. Hypopituitarism may present as a deficiency of individual anterior or posterior pituitary hormones or as a complete deficiency of all pituitary hormones, known as panhypopituitarism. We present a case of a 67-year-old male with a long-standing macroadenoma, previously treated as a prolactinoma, complicated by anterior pituitary hormonal deficiency.

Case report: A 67-year-old male was diagnosed with a prolactinoma nine years ago and was started on cabergoline (0.5 mg, half a pill twice weekly). Upon admission to our hospital in 2024, he presented with progressively worsening blurred vision, fatigue, low energy, and hypotension. Given his deteriorating symptoms, cabergoline was discontinued, and a comprehensive endocrine evaluation, along with magnetic resonance tomography (MRT), was performed. Imaging revealed a 48 mm pituitary macroadenoma compressing the optic chiasm, explaining the patient’s worsening vision. Laboratory tests confirmed secondary adrenal insufficiency and secondary hypothyroidism. The patient was started on hydrocortisone and levothyroxine to manage his endocrine deficiencies. Following stabilization, he underwent transsphenoidal pituitary macroadenoma resection in July 2024. Postoperatively, his symptoms significantly improved, except for persistent visual impairment. At a follow-up visit after surgery, the patient reported drowsiness. Laboratory tests revealed that his Free T4 levels were within the lower normal range, prompting an increase in the levothyroxine dosage. Following this adjustment, the patient experienced symptomatic improvement.

Conclusion: This case highlights the importance of regular endocrine reassessment in patients with pituitary adenomas. Early recognition and management of secondary endocrine deficiencies are essential for optimizing patient outcomes, as untreated deficiencies can lead to severe complications and even death. Although surgery successfully resolved most symptoms, persistent visual impairment underscores the need for timely intervention in pituitary macroadenomas.