SPONTANEOUS CURE OF HYPOPITUITARISM

A 35-year-old man presented with an apparently short history and clini cal features of hypopituitarism. The diagnosis was confirmed by the fo llowing investigations: random plasma cortisol 79 mmol/L (normal = 200 -770 mmol/L), total thyroxine 47 nmol/L (normal = 60-154 nmol/L), plas ma testosterone 3.5 nmol/L (normal = 9-32 nmol/L), FSH 2.2, LH 2.0 IU/ L (normal = 2-20 IU/L), and no significant rise of cortisol and growth hormone to insulin hypoglycemia. There was no abnormality of the pitu itary on CT examination. He had a good response to replacement therapy but 3 years later ceased all hormone replacement, felt well, and basa l plasma cortisol, thyroxine, FSH, LH, and testosterone were normal. A combined pituitary function test 8 years after presentation was norma l. Fourteen years later he is clinically well with normal basal cortis ol, thyroxine, TSH, FSH, LH, ACTH, and testosterone; and MRI examinati on showed that the anterior pituitary gland and stalk were of normal d imensions but the right two-thirds of the pituitary appeared nonfuncti onal. It is believed that there has been spontaneous regeneration of a nterior pituitary tissue after destruction, probably by infarction sev ere enough to produce panhypopituitarism. The relation of this event t o a severe illness with headache and prostration 7 years before presen tation is doubtful because of his fertility during this time.