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.