Pancytopenia secondary to hypopituitarism may just be due to hypothyroidism alone

Lee, Acw

doi:10.1007/s00277-010-0938-9

Cited by 11 publications

(6 citation statements)

References 2 publications

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“…We reviewed nine cases by using Medline search ( Table 2). Six of these cases were associated with Sheehan syndrome [4][5][6][7][8][9], one was associated with macroprolactinoma [10], and one with hypothalamic glioma and one with suprasellar germinoma [11,12]. To the best of our knowledge, this is the first case of pancytopenia secondary to hypopituitarism.…”

Section: Discussionmentioning

confidence: 82%

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

et al. 2012

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We present the case of a patient with acromegaly who had pancytopenia with hypopituitarism secondary to the excision of a pituitary macroadenoma and radiation therapy. A 28-year-old man presented with pancytopenia and serum electrolyte abnormalities. He was diagnosed with acromegaly and underwent surgery and gamma-knife radiotherapy for a pituitary macroadenoma at the age of 22 years. A recent brain magnetic reso nance imaging showed an empty sella, and the basal hormonal profile demonstrated deficiencies of pituitary hormones except thyrotropin. As presenting pancytopenia, his bone marrow biopsy showed hypocellular marrow. The total number of hemocytes increased after hydrocortisone replacement. Hypopituitarism was a possible cause of pancytopenia, and glucocorticoids had crucial effects on converting pancytopenia to normal in this case. (Endocrinol Metab 27:308-313, 2012)

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Section: Discussionmentioning

confidence: 82%

“…Lee [12] described a case of an 11-year-old girl who developed postablative hypothyroidism and prolonged pancytopenia after radiotherapy for a suprasellar germinoma while receiving cortisol replacement. Hence, the authors believed that hypothyroidism was a major contributing factor to pancytopenia in patients with panhypopituitarism.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2012

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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: 99%

“…Panhypopituitarism refers to a deficiency of the five hormones produced in the anterior pituitary and released from the hypothalamus: somatotropin (growth hormone [GH] January 13, 2015 between bone marrow health and the pituitary seems likely, given the rapid resolution of hematologic abnormalities with hormone replacement therapy. [1][2][3][4][5][6][7][8][9][10] In humans, isolated hormone deficiencies can affect hematopoiesis. Severe hypothyroidism can result in normocytic anemia.…”

Section: Discussionmentioning

confidence: 99%

“…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. The addition of levothyroxine-despite normal TSH levels-led to the rapid resolution of the pancytopenia, which argues for a critical role played by thyroid hormones in hematopoiesis.…”

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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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Relapsing thrombocytopenia leading to the diagnosis of pre-symptomatic Hashimoto's thyroiditis

Lee

2011

Ann Hematol

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Pancytopenia secondary to hypopituitarism may just be due to hypothyroidism alone

Cited by 11 publications

References 2 publications

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

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

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

Relapsing thrombocytopenia leading to the diagnosis of pre-symptomatic Hashimoto's thyroiditis

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