title: Hormones and the bone marrow: panhypopituitarism and pancytopenia in a man with a pituitary adenoma.
abstract: In rare cases, pancytopenia results from hormonal deficiencies that arise in the setting of panhypopituitarism. Here we describe the unusual case of a 60-year-old man who presented with progressive fatigue and polyuria, and whose laboratory workup revealed a deficiency of the five hormones associated with the action of the anterior pituitary (thyroid hormone, testosterone, cortisol, prolactin, and insulin-like growth factor-1). Imaging of the pituitary demonstrated a cystic mass consistent with a pituitary adenoma replacing much of the normal pituitary tissue. His symptoms and hematologic abnormalities rapidly resolved with prednisone and levothyroxine supplementation. While the majority of reported cases of panhypopituitarism with bone marrow suppression are the result of peripartum sepsis or hemorrhage leading to pituitary gland necrosis (Sheehan's syndrome), it is also important to consider the diagnosis of hypopituitarism in patients with hypothyroidism, low cortisol levels, and pancytopenia. The causal relationship between pancytopenia and panhypopituitarism is not well understood, though it does reinforce the important influence of these endocrine hormones on the health of the bone marrow.
authors.affiliation: Division of Hematology, Massachusetts General Hospital Cancer Center, Yawkey 7B, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: Dianna
authors.initials: D
authors.lastname: Lang
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Mead
authors.forename: David B
authors.initials: DB
authors.lastname: Sykes
mesh_terms: D000236:Adenoma / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D001853:Bone Marrow / Q000473:pathology; D004359:Drug Therapy, Combination; D006403:Hematologic Tests; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007677:Kidney Function Tests; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use*; D035583:Rare Diseases; D013974:Thyroxine / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013974:Thyroxine; D011241:Prednisone