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Case report
Cyclical haematological changes in a case of hypopituitarism
  1. Rahul Nema,
  2. Abhinav Sengupta,
  3. Arvind Kumar and
  4. Naveet Wig
  1. Department of Medicine, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr Arvind Kumar; linktoarvind{at}gmail.com

Abstract

A 40-year-old woman presented to our emergency department in an altered state following a generalised tonic-clonic seizure. On regaining consciousness, she gave a history of bleeding tendencies and menorrhagia, fatigue, nausea, vomiting and appetite loss for a long time. She had received multiple blood transfusions in the last 10 years. Investigations revealed severe hyponatraemia, transaminitis and pancytopenia, which showed cyclical fluctuations in the hospital. Hyponatraemia was attributed to a central cause owing to secondary hypothyroidism and hypocortisolism on evaluation. A diagnosis of cyclical thrombocytopenia was made by logging the trends of blood cell lines and applying the Lomb-Scargle test. Liver biopsy showed features of transfusion hemosiderosis explaining transaminitis. All of the haematological abnormalities and clinical symptoms resolved on thyroxine and corticosteroid replacement, suggesting causal association hypopituitarism with cyclical thrombocytopenia

  • pituitary disorders
  • haematology (incl blood transfusion)
  • fluid electrolyte and acid-base disturbances

https://doi.org/10.1136/bcr-2021-243421

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    Footnotes

    • Twitter @linktoarvind

    • Contributors RN was involved in primary management of the case, with contributions in designing the work, revising it for critically important content, and final approval of the version published. All authors will be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. AS was involved in primary management of the case, with contributions in literature review, revising it for critically important content, and final approval of the version published. AK and NW have contributions in revising the work for critically important content, and final approval of the version published.

    • 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.

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