Hypogonadism due to pituitary macroadenoma with inflammatory bowel
disease and hemolytic anemia in a 22 years old Sudanese patient.
CASE REPORT STUDY
Authors:
A\First authors : FADI M. TOUM AHMED 1, FAYHAA MAHMOOD
MADANI MAHMOOD 2
B\Second authors :DANIA ABDALLA HASSAN DIAB 3, MOJAHID
ALTEIB YOUSIF ALTEIB 4, MONZER MOHAMMED ALMAHDI ALI SAIFALDEEN 5
C\Third authors :SAMER MOHAMMED AHMED BALLA 6, AHMED
BABIKER ELTAYP MOHAMMED 7, KHALID ALI MUSTAFA FADLALLAH 8, MOHAMMED
FAISAL ABBAS BABIKIR 9 ,YASIR AHMED ISMAIL ELDAI10
Affiliation:
1 Internal medicine specialist, sinnar university, sinnar , sudan
2 registrar of internal medicine , sinnar , sudan
3university of sinnar sinnar sudan
4 university of sinnar sinnar sudan
5university of sinnar sinnar sudan
6university of sinnar sinnar sudan
7university of sinnar sinnar sudan
8 university of sinnar sinnar sudan
9 university of sinnar sinnar sudan
10 University of sinnar sinnar sudan
Authors Email addresses:1\
fadi.mtoum2022@gmail.com
2\
Fayhaa_mahmood_madani@gmail.com
3/
daniaabudallah@gmail.com
4/
mogahedhalaly12389@gmail.com
5/
mohammedalmahdimonzer@gamil.com
6/
samermohammed0303@gmil.com
7/
ahmedbabiker2000a@gmail.com
8/
khalidelmustafa1226@gmail.com
9/
mohammed.f.a.babikir@gmail.com
10/
yasoahmed270@gmail.com
Abstract
We report a case of a Patient who presented in our medicine department
with headache and body aches for 3 days, cough and fever for 2 days,
vomiting, and diarrhea for 1 day.
On physical examination, the patient showed features of thalassemia and
hemic murmur over the pericardium. He was suffering from a long history
[for more than 10 years ] of recurrent attacks of anemia at the
frequency of one admission every 2 months, and every time was receiving
blood and also has a history of bloody diarrhea 3 times before, and
recurrent diarrhea since 2010, HB electrophoresis was normal, and serial
upper GI endoscopy was done the last one showed mild erosion in the
stomach and duodenum. also, a serial colonoscopy done in the last one
showed multiple erosive and skip lesions, and a biopsy was taken and the
result showed lymphocytic infiltration , which confirmed inflammatory
bowel disease. hormonal analysis was done and showed features of
hypogonadism and imaging revealed a pituitary macroadenoma.
1-Introduction
Hypogonadism is a typical endocrine disorder. A man is considered to
have hypogonadism according to the Endocrine Society if he exhibits
symptoms and physical manifestations of a low level of free or total
testosterone in his blood as well as clear-cut, consistent low serum
levels of these substances. In contrast, the 2018 definition of
hypogonadism by the American Urological Association employs a blood
total testosterone level < 300 ng/dL in conjunction with
hypogonadism-related symptoms or signs.The doctor must assess the levels
of serum luteinizing hormone and follicle-stimulating hormone to
distinguish between primary (testicular) and secondary
(pituitary-hypothalamic or central) hypogonadisms. Therefore, one must
explore possibly reversible reasons in the hypothalamus-pituitary axis
if gonadotropins are low or inappropriately normal. In such cases, serum
prolactin and iron levels should also be checked. Other pituitary
hormone assessments including pituitary magnetic resonance imaging (MRI)
may be required when clinically needed. In the event that a pituitary
adenoma is suggested by severe pituitary hormone abnormalities, such as
increased serum prolectin or MRI(1)
Inflammatory bowel disease has a consistently rising prevalence, has
been an issue in healthcare across the world. It comes in two main
varieties: ulcerative colitis (UC) and Crohn’s disease (CD), which are
separate inflammatory chronic bowel diseases that relapse often. Any
area of the digestive system can be affected by CD, which can produce
transmural inflammation. The perianal region or terminal ileum are the
most often affected areas. A CD is frequently accompanied by problems
such abscesses, fistulas, and strictures, unlike UC. The colon is the
only part of UC that affects patients and it is characterized by mucosal
inflammation.(2).
A subgroup of hemolytic anemia known as microangiopathic hemolytic
anemia (MAHA) is characterized by fragmentation and hemolysis brought on
by injury to erythrocytes in the tiny blood capillaries.(3)
2-PATIENT INFORMATION
Our patient is 22 years old man who presented on 28/1/2022 complaining
of headache and body ache for 3 days, cough and fever for 2 days,
vomiting, and diarrhea for 1 day. His condition started with the gradual
onset of a moderate headache all over the head associated with fever
(which was low grade mainly in the evening, not associated with rigor or
chills), the headache was also associated with neck pain, and not
associated with bullring of vision or projectile vomiting. The cough was
dry and associated with stapping chest pain all over the chest which was
aggravated by the cough without shortness of breath. The vomiting was
small in volume, 3 times daily, aggravated by cough, and contains food
particles not associated with nausea or abdominal pain. The diarrhea was
also small in volume in form of loose stool and does not contain blood
or mucous.
Other systems were unremarkable in history.
Regarding his past medical history, the patient had been suffering from
a long history (for more than 10 years) of recurrent hospital admission
due to recurrent attacks of anemia at the frequency of one admission
every 2 months, and every time was receiving blood, and also has a
history of bloody diarrhea 3 times before, and recurrent diarrhea since
2010.
The patient had undergone an appendicectomy in July 2021.The patient is
not diabetic or hypertensive.many investigations were done to reach the
diagnosis as I’ll describe below.His drug, family, and social history
were unremarkable.