SUN-441 Clinical Presentation And Diagnosis Of Primary Hypophysitis In Pediatric Age, Regarding A Case.

Abstract

Objective: To determine the clinical presentation and diagnosis of primary hypophysitis in pediatric age. Clinical case: A 14-year-old patient initially assessed for idiopathic headache and hypopituitarism who received hormone replacement therapy with growth hormone from 6 years to 10 years. He received corticosteroid pulses initially with partial improvement of headache. After remaining 4 years asymptomatic in irregular treatment with levothyroxine and prednisone, he went back San Borja Child Health Institute for presenting polyuria and polydipsia associated with moderate intensity headache. The case was reassessed based on clinical findings and imaging as a diagnosis of hypophysitis. Hypogonadism was evidenced and hormone replacement therapy with testoterona was decided. Discussion: Hypophysitis, mostly, are usually seen in the post-partum period suggesting that it has an autoimmune base, however it is increasingly frequent the report of cases such as the one presented whose diagnosis is independent of pregnancy. Efficacy of medical treatment is still controversial. These affected patients have a preferential hypofunction by corticotropas and tirotropas cells although it is also usually associated as an increasingly commonly described finding hypogonadism as found in the presented patient. Conclusion: Hypophysitis may be highly suspicious on the basis of clinical features and radiological findings. We must suspect this entity when a patient presents hypopituitarism and headaches of an intensity in disproportion to the size of the gland associated to suspicious magnetic resonance imaging.