P-46 Panhypopituitarism in a patient with Acute Myeloid Leukemia

Abstract

Abstract Introduction Panhypopituitarism with acute myeloid leukemia (AML) is a very rare condition. Few cases reported in the literature have been generally associated with poor prognosis. Clinical Case Here we present A 57-year-old female patient with AML-M2. In the first year of her follow-up, she was diagnosed with central diabetes insipidus (DI)- Arginine vasopressin deficiency, when she was referred to the endocrinology clinic with complaints of fatigue, polydipsia and polyuria. Hypopituitarism was found following further investigations including pituitary hormones (Table 1). Magnetic resonance imaging (MRI) of the pituitary gland revealed a a heterogeneous contrasting lesion of approximately 15×11×21 mm, which is isointense with gray matter. Pituitary stalk was observed thickened. Differentiation between lymphocytic hypophysitis and macroadenoma could not be made (Figure 1). Visual field examination was normal. When clinical, laboratory and radiological findings were evaluated together, panhypopituitarism was considered and empirical treatment was started including prednisolone 5 mg daily, levothyroxine 75 mcg daily, and Desmopressin acetate hydrate (DDAVP) 0.600 twice daily without performing a fluid restriction test. The patient had relocated because of social reasons. She applied to another endocrinology out-patient clinic for follow-up controls and reported that she first reduced the desmopressin to half dose and then stopped because she felt amelioration of symptomes. Her urine output during this admission amounted to 2 liters/day without receiving desmopressin. Laboratory workup also supported recovery of DI - Arginine vasopressin deficiency (Table 1). Since basal cortisol values were found to be within normal limits, steroid was also reduced and discontinued, but the need of replacement for hypothyroidism continued. In the control pituitary MRI, the changes of pituitary gland and stalk observed in the prior imaging was seen disappeared (Figure 1). Although the patient did not receive any specific treatment for hypophysitis other than AML treatment, clinical and radiological improvement was observed. She is still doing well on levothyroxine treatment. Cytarabine (ara-c) and idarubicin, hematopoietic stem cell transplantation and venetoclax treatments were applied for AML, respectively and the patient was considered as remission. Resolution of hypophysitis may be associated with remission of AML.Figure 1.Pituitary MRI at diagnosis and follow-up Table 1.Laboratory findings of the patient at baseline and follow-up