Incidental Discovery of Pituitary Insufficiency after Non-pituitary Surgery

T. Khutsishvili*^a (Dr)

^a Todua Clinic, Tbilisi, GEORGIA

* Khutsishvilitamuna@gmail.com

Introduction: Pituitary Insufficiency is life threatening condition, that can lead or manifest by any stressful situation (surgery, infections, intoxication and etc)

Case report:

A 70-year-old man diagnosed with Bladder Cancer had underwent surgery - Cystoplasty. The operation was performed without complications, but, after the intervention, the general condition of the patient sharply declined. There appeared strong general weakness, blurred consciousness, frequent abdominal pains, bradycardia, lowering of T/A(<80/50 mmHg) , fever. His condition required intensive care.

Observations:

Laboratorial tests:

Na - 133-135 (130-152)mmol/l, K - 3.7 (3.6-5.2)mmol/l, CRP - 173 (<5)mg/l, creatinine - 132 µmol/L, CBC - Leukocytosis, Urine total - bacteria - 205 cell/ul (<11.4) ,

Consultations with a Neurologist, Infectionist, Endocrinologist were conducted. TSH, FT4 tests were prescribed, we got a remarkable results - TSH - 1.25 (0.4-3.7) mIU/L, FT4-4.72 (12-22) pmol/l. Besides that, based on the recommendation of a Neurologist, the patient underwent MRT examination of the brain. An introspectively revealed changes (adenoma?) was seen as the result of examination that is more likely to be Pituitary apoplexy (P/A).

According to the findings, there was a doubt that it could be Central Hypothyroidism. The following studies have been scheduled: Cortisol , ACTH in Blood . So we have got worrisome results again: Cortisol - 3,9 (4,3-22,4) ug/dl, ACTH -3.36 (1.6-10.21) pmol/l.

According to lab tests (Low Ft4, normal TSH, low cortisol, MRT results) patient was likely to have pituitary hypofunction, that causes central hypothyroidism and central hypocorticism.

The patient was diagnosed with the following: Pituitary Hypofunction (E27) Pituitary damage, unspecified (E27.3) Other hypothesized hypothyroidism (E03.8), Malignant tumor of the bladder, unspecified (Ch 67.9)

Prescription: -Hydrocortisone 20 mg/day , In two days - Euthyrox 37 mcg/day

2-3 days after the medication administration patient’s condition improved dramatically, T/A, pulse, temperature had been normalized (Antibiotic therapy due to urine infection was going). Patient got active, started adequate speech, movement and communication.

We have checked Patient’s lab tests in 10 days - TSH -1.8 (0.4-3.7) mIU/L , FT4- 8(12-22) pmol/l, Cortisol -13 (4,3-22,4) ug/dl , he was discharged home. Repeated examination of MRT of the brain, monitoring Pituitary, thyroid hormones ,electrolytes is planned. Patient should be under constant supervision of an Oncologist and Endocrinologist.

The author has declared no conflict of interest.