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Rare disease
Case report
Neurosarcoidosis presenting with hypopituitarism
  1. Elina Liu1,
  2. Axel Rohr2 and
  3. Mohammed AlMehthel3
  1. 1Department of Internal Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Department of Neuroradiology, The University of British Columbia, Vancouver, British Columbia, Canada
  3. 3Department of Endocrinology, The University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Elina Liu; eliu{at}qmed.ca

Abstract

Hypothalamo-pituitary sarcoidosis is a rare manifestation of sarcoidosis, usually presenting alongside other symptoms of neurosarcoidosis. We describe the case of a 58-year-old man from Ghana who presented with progressive gait disturbance, cognitive dysfunction, hypothermia and bradycardia. He was found to have pituitary stalk thickening on imaging, and lymph node biopsy identified non-caseating granulomatous disease. Serology revealed gonadotropin deficiency, hypothyroidism and central adrenal insufficiency. Treatment with immunomodulatory therapy resulted in resolution of findings on imaging and improved cognition, though pituitary function never recovered. Treatment for his sarcoidosis unfortunately resulted in recurrent infections and avascular necrosis. Work-up, management and ongoing care required multidisciplinary cooperation between the admitting internal medicine team, infectious diseases, respirology, rheumatology, endocrinology and neurology.

  • pituitary disorders
  • neuroendocrinology

https://doi.org/10.1136/bcr-2020-235077

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    Footnotes

    • Contributors This statement confirms that all authors made significant contributions to the work, drafted and revised the manuscript, and approved the final version that has been submitted today. EL completed the preliminary draft of the case report, completed the literature search associated with completion of the case report, acquired consent, completed editing and revision, and completed/submitted the final revision. AR completed acquisition and interpretation of images, editing and revision of preliminary drafts of the case report, and approved the final revision prior to submission. MA was the PI of the case report responsible for planning and conception of the case report, editing and revision of preliminary drafts of the case report, and approved the final revision prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.