POS-588 CHRONIC HYPOTENSION REVEALING AN ANTERIOR PITUITARY DEFICIENCY IN HEMODIALYSIS PATIENT: A CASE REPORT

Abstract

Chronic kidney disease (CKD) naturally progresses with hormonal disorders. However, disturbances in the hypothalamic-pituitary-gonadal axis in hemodialysis patients remains underdiagnosed and commonly interpreted as harmless uremia effects. We here report an unusual case of a patient undergoing long-term hemodialysis who exhibited Adrenocorticotropic Hormone Deficiency, hypogonadotrophic hypogonadism and primary hypothyroidism. A 43-year-old male with end-stage renal disease secondary to primitive hyperoxaluria, undergoing hemodialysis for 16 years, with a history of primary infertility for 9 years, developed 9 months ago severe weakness and lethargy, more frequent hypoglycemic episodes in hemodialysis sessions, with the onset of a severe chronic hypotension (systolic blood levels at 70-80mmHg before hemodialysis sessions). Examination revealed gynecomastia. He did not exhibit electrolyte imbalances, such as hyponatremia or hyperkalemia, had normal morning blood levels of cortisol and a correct heart function. Endocrinological examinations tests showed an adrenocorticotropic hormone deficiency, a primary hypothyroidism, gonadotrophic hormones deficiency with low testosterone levels and high prolactin levels (ACTH=2,64pg/l, TSH=0,24uUI/ml, LH=3,35mUI/ML, testosterone= 1,83ng/l, prolactin=58,4ng/ml). After commencement of corticosteroid replacement therapy, his symptoms resolved without complications. A cerebral magnetic resonance imaging, and an adrenal scan were undergoing to determine the etiology. We don’t have the results yet. Even though endocrine disorders are common in hemodialysis patients and frequently not associated with apparent diseases, disorders in the hypothalamic-pituitary axis may increase cardiovascular and metabolic risk. Therefore, they should be screened and treated rapidly.