Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

Koh, Jung Hee; Lee, Yong Jae; Kang, Junmo; Choi, Bo Kwang; Jeon, Yun Kyung; Kim, Sang Soo; Kim, Bo Hyun; Kim, In Joo

doi:10.3803/enm.2012.27.4.308

Cited by 2 publications

(3 citation statements)

References 18 publications

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“…As mentioned previously, less common conditions can also result in damage to the anterior pituitary and subsequent pancytopenia, including reported cases of hypothalamic glioma, 27 macroprolactinoma, 4 empty sella syndrome, 28 and suprasellar germinoma, 9 as well as in patients following pituitary surgery and radiation for a functional macroadenoma 29 and where the condition was idiopathic.…”

Section: Discussionmentioning

confidence: 85%

“…8 A 28-yearold man with acromegaly underwent excision of a pituitary macroadenoma, followed by radiation therapy; 6 years later, he presented with pancytopenia and hypopituitarism (with the exception of preserved thyrotropin). 29 The patient was treated with hydrocortisone replacement therapy, and the pancytopenia resolved. However, in a somewhat different case, an 11-year-old girl who developed pancytopenia following radiotherapy for a suprasellar germinoma 9 was initially treated with glucocorticoid replacement and desmopressin, but pancytopenia persisted.…”

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Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma

2015

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In rare cases, pancytopenia results from hormonal deficiencies that arise in the setting of panhypopituitarism. Here we describe the unusual case of a 60-year-old man who presented with progressive fatigue and polyuria, and whose laboratory workup revealed a deficiency of the five hormones associated with the action of the anterior pituitary (thyroid hormone, testosterone, cortisol, prolactin, and insulin-like growth factor-1). Imaging of the pituitary demonstrated a cystic mass consistent with a pituitary adenoma replacing much of the normal pituitary tissue. His symptoms and hematologic abnormalities rapidly resolved with prednisone and levothyroxine supplementati on. While the m ajority of r eported cases of panhypopituitarism with bone marrow suppression are the result of peripartum sepsis or hemorrhage leading to pituitary gland necrosis (Sheehan's syndrome), it is also important to consider the diagnosis of hypopituitarism in patients with hypothyroidism, low cortisol levels, and pancytopenia. The causal relationship between pancytopenia and panhypopituitarism is not well understood, though it does reinforce the important influence of these endocrine hormones on the health of the bone marrow. CASE PRESENTATIONA 60-year-old man was admitted to Massachusetts General Hospital with chest pain thought to be the result of his longstanding gastroesophageal reflux disease. He had a history of glaucoma, atypical nevi, and diverticulosis. He reported progressively worsening fatigue and weakness, a 10 lb weight loss, polyuria, and increased thirst. Laboratory testing on presentation was notable for hyponatremia (116 mmol/L) and pancytopenia. Out of concern for an underlying malignancy, the patient underwent contrast-enhanced computed tomography scans of the chest, abdomen, and pelvis, which were unremarkable. Given his progressive fatigue and hyponatremia, a morning serum cortisol level was checked and found to be very depressed (1.0 μg/dL; normal range 5-25 μg/dL). This prompted a more extensive endocrine evaluation (Table 1) that resulted in documentation of low levels of thyroid hormone, cortisol, testosterone, prolactin, and insulin-like growth factor-1 (IGF-1). A diagnosis of panhypopituitarism was made based on the reduced levels of all five hormones associated with the action of the anterior pituitary. A cosyntropin stimulation test demonstrated an inappropriately low increase in serum cortisol levels (1.2 to 7.4 μg/dL), suggesting reduced adrenal responsiveness due to prolonged adrenocorticotropic hormone (ACTH) deficiency. Though euvolemic, the patient displayed hyponatremia, with elevated urine osmolality, suggesting a component of elevated antidiuretic hormone (ADH) thought to be compensatory in the setting of glucocorticoid deficiency.In evaluation of the pituitary gland, MRI demonstrated a 6 mm cystic lesion in the posterior aspect of the pituitary (Fig. 1a). The radiologic appearance was most consistent with a cystic pituitary adenoma compressing and replacing the normal tissue of the pituitary gland. ...

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Section: Discussionmentioning

confidence: 85%

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confidence: 99%

Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma

2015

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“…Severe hypothyroidism can also cause normocytic anemia. Growth hormone deficiency, cortisol, and prolactin may cause bone 24,25 marrow abnormalities.…”

Section: Discussionmentioning

confidence: 99%

A 24-Year-Old Male with Gigantism, Growth Hormone Deficiency, Suspected Clivus Chordoma, Primary Hypothyroidism, Hypogonadism and Pancytopenia

Arsana¹,

Pramudianti²

2019

Indonesian J. Clin. Pathol. Med. Lab.

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Preeliminary : Pituitary gigantism is a condition caused by the excessive secretion of growth hormone (GH). Growth Hormone is also the most common pituitary hormone deficient in pituitary disease. Chordoma is a bone primary tumor that grows slowly and rarely found. Hypothyroidism is a pathological condition due to thyroid hormone deficiency. Symptoms of hypogonadism is non-specific including libido disorders, erectile dysfunction and decreased muscle mass and no hair growth in the head or body. Case : A 24-year-old man came with a knee-jerk complaint. Physical examination obtained increased growth of statural and body parts as well as loss of body hair. Laboratory investigation revealed pancytopenia, increased prolactin; decreased GH, IGF-1 and testosterone; increased TSH, decreased FT3 and FT4. Head MRI demonstrated the presence of mass in the clivus.Discussion : In this case, the patient presents with clinical gigantism. However, laboratory examination shows decreased GH and IGF-1 which may be due to the suppressive effect of mass on the clivus bone to the pituitary. The suspicion of hypothyroid found alone or due to mass in the clivus bone still requires further examination. Hypogonadism can result from supression on the pituitary. Pancytopenia can be caused by deficiency of GH or from hypothyroidism.Conclusion : Gigantism may occurred with deficiency GH and IGF-1 due to suppressed pituitary caused by chordoma.

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Pancytopenia Associated with Hypopituitarism in an Acromegaly Patient: A Case Report and a Review of the Literature

Cited by 2 publications

References 18 publications

Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma

Hormones and the Bone Marrow: Panhypopituitarism and Pancytopenia in a Man with a Pituitary Adenoma

A 24-Year-Old Male with Gigantism, Growth Hormone Deficiency, Suspected Clivus Chordoma, Primary Hypothyroidism, Hypogonadism and Pancytopenia

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