Endocrine Abstracts

JOINT1376

Hypopituitarism is an uncommon condition with limited data from Nepal. We retrospectively reviewed data of 36 patients who attended our endocrine center from April 2013 to March 2024. The mean age was 35.88 ± 7.17 years (range 3-69 years). 6 patients were ≤18 years. There were 18 (50%) males and 18 (50%) females. The mean BMI was 25.52 ± 4.76 kg/m² (range 14.9 - 33.3). The most common symptom was nausea/vomiting in 14 patients (38.8%) followed by fatigue in 13 patients (36.1%). Visual abnormalities were detected in 12(33.3%) and headache in 12(33.3%) patients. Out of 18 female patients, 15(83.3%) had menstrual disturbances. Secondary amenorrhea was present in 13 patients (72.2%), infertility in 4 patients and loss of libido was present in 3 patients. 2(5.5%) patients presented with pituitary apoplexy. Surgery was the most common cause for hypopituitarism {14(38.8%) patients}, idiopathic in 13 patients (36.1%), surgery + post radiation in 6 (16.6%) patients, Sheehan’s syndrome in 2(5.55%) patients, post radiation in 1 patient (2.77%). Co-morbidities like diabetes were seen in 7 (19.4%) and hypertension in 5(13.8%) patients. One patient had four components of hypopituitarism (hypogonadism +hypothyroidism +hypocortisolism +AVP-D) while most patients 18(50%) had only 2 components (hypocortisolism + hypothyroidism). Hypothyroidism was present in 34 (94.4%) patients. Pituitary adenoma was detected in MRI in 12 patients (33.3%). Among them, 2 had macroprolactinoma, 2 ACTH dependent Cushing disease, 1 had Thyrotropinoma and rest had Nonfunctioning pituitary adenoma (NFPA). Craniopharyngioma was seen in 6 patients (16.6%), Empty sella in 8(22.2%), Meningioma in 2(5.5%) and Rathke cleft cyst 1(2.7%) patient. 7 (19.4%) patients had normal MRI findings. Management was with steroids+ thyroxine+ Hormone Replacement Therapy (HRT) +desmopressin in 3 patients, steroids+ desmopressin in 1 patient, steroids+ thyroxine HRT in 9 patients, steroids + HRT + desmopressin in 1 patient, steroids + thyroxine + desmopressin in 2 patients, steroids + thyroxine in 15 patients, thyroxine + HRT in 4 patients and HRT alone in 1 patient (although he was also GH deficient). Steroids used were prednisolone in 25 patients and hydrocortisone in 6 patients. HRT used was OCP in 7 patients, testosterone in 8 patients, HCG and FSH/HMG in 2 patients, both of them (one male, other female) had successful pregnancies. Desmopressin was nasal in 5 patients and oral in 2 patients.