Hypopituitarism

Abstract

A 44-yr-old African-American woman presented with a 7-yr history of amenorrhea, tiredness, unexplained fatigue, weakness, dry skin, and thinning of the hair. She remained healthy until age 37, when she developed oligomenorrhea and thinning of axillary and pubic hair, with loss of hair over the parietal area. Serum thyroid-stimulating hormone (TSH) levels done on two separate occasions were reported to be “normal.” Three years before her presentation, and at the age of 41, she was admitted to a hospital with headaches, lethargy, and nausea. The diagnosis of obstructive hydrocephalus was made. She had an emergency ventriculostomy, followed by a right-sided V-P shunt, which she continues to have. Work-up at that time included a lumbar puncture (WBC = 6/mL, glucose = 64 mg/ dL, protein = 17 mg/dL, VDRL = nonreactive) and a MRI of brain without contrast, which revealed an empty sella and postoperative changes. Other findings during that admission included hyponatremia (Na = 122 mmol/L), normocytic anemia, and leukopenia (WBC = 2500/μL, Hct = 33%). A bone marrow biopsy revealed noncaseating granulomas. The diagnoses of collagen vascular disease, not otherwise specified and the syndrome of inappropriate antidiuretic hormone (SIADH) were made. She was discharged home on oral sodium supplements (NaC1, 2 g/d), fluid restriction, and phenobarbital for seizure prophylaxis. The latter was discontinued because of increasing lethargy.