Pituitary Macroadenoma with Hypogonadism in 30 year old Liver Cirrhosis Patient: A Case Report
DOI:
https://doi.org/10.66266/inajemd.v2i1.46Keywords:
pituitary macroadenoma, hypogonadism,, liver cirrhosis, therapeutic interventionAbstract
Pituitary macroadenomas can suppress pituitary hormone secretion, one of which is the gonadotropin hormone, causing hypogonadism. The condition of hypogonadism can increase the risk of NAFLD, which can then become liver cirrhosis. A 30-year-old man came to the hospital with decreased consciousness and hematemesis melena. From physical examination, laboratory, and pituitary MRI, the patient was diagnosed with pituitary macroadenoma, hypogonadotropic hypogonadism, primary hypothyroidism, acute adrenal insufficiency, and liver cirrhosis. The patient was given hydrocortisone therapy, correction of electrolyte levels, hypoglycemia protocol, levothyroxine 100 mg/day, and management of hematemesis melena. After that, Sustanon 250 mg was given every two weeks intramuscularly. The patient went home in good condition and was planned for neurosurgery consultation for transsphenoidal resection. After the injection of Sustanon, the patient experienced increased penile length and testicular volume. The condition of hypogonadism in patients with pituitary macroadenoma can be a risk factor for NAFLD, which can then progress to liver cirrhosis. NAFLD and liver cirrhosis also can cause hypogonadism in men by several mechanisms. The patient has been well-managed and experienced clinical improvement.
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1. Melmed S. Pituitary masses and tumors. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, editors. Williams Textbook of Endocrinology. 14th ed. Philadelphia: Elsevier; 2020. p. 236–302.
2. Banskota S, Adamson DC. Pituitary adenomas: from diagnosis to therapeutics. Biomedicines. 2021;9(5):494.
3. Zhang Z, Chen C, Wang Y, Wang N, Chen Y, Lu Y, Xia F. The association of total testosterone with probable nonalcoholic steatohepatitis and nonalcoholic fatty liver disease fibrotic progression in men with type 2 diabetes: a cross-sectional study. Eur J Med Res. 2022;27:307.
4. Khullar V, Firpi RJ. Hepatitis C cirrhosis: new perspectives for diagnosis and treatment. World J Hepatol. 2015;7(14):1834–55.
5. Esposito D, Olsson DS, Ragnarsson O, Buchfelder M, Skoglund T, Johansson G. Nonfunctioning pituitary adenomas: indications for pituitary surgery and post-surgical management. Pituitary. 2019;22:422–34.
6. Hwang Y, Lee HW, Ahn SH, Lee EJ, Ku CR, Kim SU. Positive association between nonalcoholic fatty liver disease and growth hormone deficiency in patients with
nonfunctioning pituitary adenoma. Front Endocrinol. 2023;13:1057769.
7. Mody A, White D, Kanwal F, Garcia JM. Relevance of low testosterone to non-alcoholic fatty liver disease. Cardiovasc Endocrinol. 2015;4(3):83–9.
8. Kim SM, Yalamanchi S, Dobs AS. Male hypogonadism and liver disease. In: Winters S, Huhtaniemi I, editors. Male Hypogonadism. Contemporary Endocrinology. Humana Press; 2017.
9. Song MJ, Choi JY. Androgens dysfunction in non-alcoholic fatty liver disease: role of sex hormone-binding globulin. Front Endocrinol. 2022;13:1053709.
10. Punekar P, Sharma AK, Jain A. A study of thyroid dysfunction in cirrhosis of liver and correlation with severity of liver disease. Indian J Endocrinol Metab. 2018;22(5):645–50.
11. Wentworth BJ, Siragy HM. Adrenal insufficiency in cirrhosis. J Endocr Soc. 2022;6(10):bvac115.
12. Penn DL, Burke WT, Laws ER. Management of non-functioning pituitary adenomas: surgery. Pituitary. 2017;21(2):145–53.
13. Pereira MP, Oh T, Joshi RS, Haddad AF, Pereira KM, Osoria RC, et al. Clinical characteristics and outcomes in elderly patients undergoing transsphenoidal surgery for nonfunctioning pituitary adenoma. J Neurosurg. 2020;49(4).
14. Bhasin S, Brito JP, Cunningham GR, Hayes FJ, Hodis HN, Matsumoto AM, et al. Testosterone therapy in men with hypogonadism: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103(5):1715–44.
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