Session: SAT 164-196-Pituitary
Poster Board SAT-164
The mechanism of liver injury in congenital hypopituitarism is still unknown. It is hypothesized that cortisol and/or growth hormone deficiency both play a role in delayed maturation of bile acid synthesis and transport, and this leads to cholestasis in infancy. The liver disease often resolves following endocrine replacement therapy, and the cholestasis resolves within 6 weeks of starting treatment with thyroxine, cortisol and GH. However, delay in diagnosis and treatment of the endocrinopathy may lead to persistently abnormal liver function tests, and in some cases to irreversible liver cirrhosis / portal hypertension. In our case patient did not take hormonal therapy and might have developed portal hypertension leading to esophageal varices and bleeding. It is likely that his former ethanol abuse contributed to his liver disease. Complete heart block occurs in hypothyroidism and is reported to be reversible with l-thyroxine replacement.
Untreated congenital hypopituitarism can present with heart block and portal hypertension with bleeding. Clinicians should be aware of associated complications and start hormonal therapy early.
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