Abstract
INTRODUCTION: -Clinical presentation of Pituitary macroadenoma and Lymphocytic hypophysitis may mimic each other. It is necessary to be cautious when one treats these patients and follow up with clinical response and hormonal and radiological evaluation is important to differentiate between the two pathologies. CASE PRESENTATION: Sixty years lady with no comorbidities presented with giddiness and vomiting for three days. She was found to have high blood pressure and was started on betablocker. This was followed by hypotension and bradycardia for which patient required admission. On admission she had persistent hypotension and bradycardia required inotropes for 48 hours. Her routine investigations were unremarkable but S. sodium was 117 (135-145 mEq/L). Endocrine reference was for persistent hyponatremia. History did not reveal any significant medical or surgical problems. She did not have headaches, visual complaints or polyuria. Clinical examination was unremarkable. Her hormonal profile was done and started on intravenous steroids. There was dramatic response to the steroid treatment. Her investigations - Urine spot Na 40 (more than 20meq/L), Urine specific gravity 1. 015 (1. 005-1. 030), Urine osmolarity 210.6mosm/kg of water (500-850) Serum osmolarity of 257.7 moms/kg(275- 295), Random bloodsugar 106 mg/dl(less than 140), Cortisol 1.91 mcg/dl (10-20), ACTH 5.59 pg/ml(10-60), Ft3 1.67pg/ml(2.3-4.1) Ft4 0.7 ng/dl(0.7-1.9) TSH 0. 05mIU/L(0.5-5. 0), Prolactin 12.5 ng/ml(less than 25), LH 1.58 IU/L(19.3-100) FSH 11.85 IU/L(25-130), uric acid 3.2 mg/dl (3.5-7.2), Glycosylated Hb 5.7% (less than 5.7),serum sodium 117 mEq/L(135-145), serum K+ 4.5 meq/L (3.6-5.2), serum creatinine 0.8 mg/dl (0.6-1.3), ACE levels 21.32 mcg/L(less than 40), antiTPO antibodies 1.82 IU/mL (less than 9), IGF1 23.6 ng/ml (55-165) . MRI pituitary showed a pituitary macroadenoma. Patient improved dramatically with intravenous steroids and thyroxine 50 mcg per day. She was discharged on oral steroids prednisolone 5 mg twice a day and thyroxine 50 mcg daily. Patient followed up after 6 weeks and was clinically stable and her Ft3 was 2.46 pg/ml and FT4 was 1. 06 ng/dl with 8 am Cortisol (without steroids) 16.3 mcg/dl and ACTH 54.4 pg/ml. Her MRI pituitary after 3 months showed a normal pituitary and clinically she was stable off steroids . She is coninued on thyroxine 50 mcg and is under regular follow up. CONCLUSION: - A female patient who presented in adrenal crisis with central hypothyroidism with radiological evidence of a pituitary macroadenoma which vanished on treatment of steroids. Retrospectively it was probably Lymphocytic hypophysitis which recovered over 3 months. Her hormonal profile improved. It is important to have a clinical index of suspicion while treating a Pituitary macroadenoma which may masquerade a Lymphocytic hypophysitis as the natural course of disease and treatment is different in both. Presentation: No date and time listed