Hypopituitarism: features of the debut and differential diagnosis (clinical case)

Hypopituitarism is an endocrine disorder characterized by the absence or decreased production of hypothalamic neurohormones and one or more pituitary hormones. The disease most often manifests itself as a deficiency of somatotropic hormone, the main clinical symptom of which is short stature in patients. In the absence of growth retardation in children, hypopituitarism can only be suspected if abnormalities in the patient's hormonal profile are detected and magnetic resonance imaging of the hypothalamic-pituitary region is performed, which complicates diagnosis and prevents timely administration of hormone replacement therapy. The article presents a clinical case of a 4-year-old patient with the onset of hypopituitarism in the form of progressive obesity in the first year of life without growth retardation. According to objective examination data, no other symptoms of endocrine pathology were detected except for excessive development of subcutaneous fat. The girl was observed for a long time by a pediatric endocrinologist and pediatrician for obesity, subclinical hypothyroidism and received hormone replacement therapy with sodium levothyroxine. The diagnosis of hypopituitarism was established only at the age of 3 years after a comprehensive inpatient examination with determination of the hormonal profile, magnetic resonance imaging (MRI) of the brain, which revealed changes in the structure of the neurohypophysis, diabetes insipidus, secondary hypothyroidism and indirect signs of secondary hypocorticism (low cortisol levels) in the child. Hypopituitarism is a disease that is quite difficult to diagnose, so it is necessary to pay more attention to patients not only with growth retardation, but also to patients with obesity resistant to standard therapy.