SUN-207 Hot Flashes, Flushing, and Sweating in a Middle-Aged Man with Pituitary Macroadenoma

Abstract

Background: Vasomotor symptoms such as hot flashes and sweating, typical of the menopausal syndrome in women, are less commonly seen in males after loss of testicular function. We present an interesting case of a middle-aged man who was evaluated for progressive episodes of hot flashes, sweating and flushing and was eventually diagnosed with pituitary macroadenoma causing secondary hypogonadism. Clinical Case: A 59 y.o. male was referred endocrinology clinic with intermittent episodes of hot flashes and sweating over the last 2 years. He has had progressive episodes of feeling warm, associated with some flushing, and then transient profuse sweating, usually lasting no more than several minutes. His only other medical problem has been chronic recurrent gout requiring Allopurinol 300 mg daily, Probenecid 500mg twice daily and Colchicine 0.6mg twice daily to prevent gout attacks. He denied any headaches, palpitations, feeling tremulous, no vision symptoms, no breast enlargement or loss of body hair, no constipation or diarrhea. Physical exam was significant for paucity of facial and body hair, and no evidence of gynecomastia. He had an episode in the office visit where he became flushed, diaphoretic, his blood pressure was 120/80 and he did not have tachycardia. Lab studies revealed Prolactin= 19 (n= 2-18 pg/dL), Cortisol 8.6 (6-27 ug/dl), Total Testosterone = 22 (n=250-1100 ng/dL), LH = <1 (n=1.5-9.3 mlU/ml), free T4 0.6 (ref 0.6-1.6 ng/dl) with TSH 1.51 (ref: 0.34 -3.00 uIU/ml), IGF-1 = 49 (34-232 ng/dl), Total metanephrines urine 654 ( 233-716 (Normotensive)), VMA = 3.6 (<8.0 mg/24 h) suggestive of secondary hypogonadism with elevated prolactin and low LH. MRI of the brain revealed mass of the sella extending into the suprasellar region measuring up to 2.0 x 2.3 x 1.8 cm. He then underwent endoscopic transsphenoidal resection of pituitary tumor and histopathology revealed null cell adenoma with widespread oncocytic changes consistent with an oncocytoma. On follow up visit in 1 month, his debilitating sweats have diminished significantly but not disappeared. Conclusion: Hot flushes are common in men who are acutely hypogonadal after orchiectomy or testicular injury, but it is an unusual symptom in patients with hypogonadism secondary to pituitary tumors. There are case reports of pituitary adenoma diagnosed through evaluation of sexual dysfunction and frequent hot flashes. This case illustrates the importance of considering broad etiologies when evaluating new onset hot flashes in middle-aged men, especially in the absence of other presenting features of pituitary macroadenoma and when symptoms of hypogonadism (like erectile dysfunction, low libido, impaired concentration and fatigue) go unreported to physicians.