Today in Endocrine Report, we discussed the case of a middle aged woman who presented with panhypopituitarism. With a special guest discussant, Mike German from Endocrinology, we learned a TON about hormone replacements in general, and also about craniopharyngiomas!___________________________________________________________________________________
Top pearls from today:
- Half-life of levothyroxine is 2 weeks. When you suspect that a patient’s symptoms may be secondary to thyrotoxicosis from over-medication, it is OKAY to hold synthroid while you check fT3, fT4 levels.
- Hyperthyroidism increases metabolism of steroids. For a patient on steroid replacement for adrenal insufficiency, new hyperthyroidism will result in increased metabolism of their replacement steroids, and likely increase their steroid needs.
- Adrenal insufficiency is hard to diagnose in patients with baseline steroid replacement, and cortisol level/cort stim test results are uninterpretable. These patients should receive a clinical (and not laboratory) diagnosis of AI.
For those craving more:
- Epidemiology: estimated 350 new cases diagnosed per year – quite rare!
- Pathology: Usually arise in the pituitary stalk and less commonly within the sella.
- Histologically, are considered benign, but the tumors frequently shorten life and hence are considered low-grade malignancies
- Clinical manifestations: field cuts due to pressure on optic chiasm, hormonal deficiencies (GH, gonadotropin, TSH, ACTH), diabetes insipidus (frequent with pituitary stalk is involved), headache, depression (independent of hormonal deficiency), nausea, vomiting, lethargy
- Treatment: 1) Surgery is indicated in almost ALL cases 2) Radiation therapy: used to treat patients with residual disease who have undergone a partial surgical resection or to treat disease that has recurred
- Think about complications of resection: 1) panhypopituitarism 2) hypothalamic dysfunction: disabling obesity, disorders of temperature regulation, sleep disorders, diabetes insipidus 3) Visual abnormalities 4) Secondary malignancies: use of radiation to treat craniopharyngiomas has been associated with secondary development of meningioma and malignant glial tumors