Bone marrow hypoplasia responsive to testosterone therapy in a patient with panhypopituitarism: need for adherence to...

To describe the case of a young Saudi male patient with long-term panhypopituitarism and pancytopenia attributable to poor adherence to androgen replacement therapy, which resolved after institution of testosterone treatment and recurred after another interval of poor adherence to recommended therapy.

We present the clinical and laboratory data before and after treatment with testosterone. In addition, the corresponding histologic changes in the bone marrow are illustrated.

After resection of a hypothalamic glioma, panhypopituitarism developed in a 14-year-old Saudi boy. At age 22 years, he had shunt-related meningitis. He was then noted to have pancytopenia, with a platelet count of 54 x 10(3)/microL, a hemoglobin concentration of 6.9 g/dL, and a leukocyte count of 2.7 x 10(3)/microL. After treatment of sepsis, the pancytopenia persisted. No underlying cause was detected. Bone marrow biopsy showed a hypocellular marrow with dysplastic megakaryocytes. The patient's family indicated that he had not been taking his testosterone therapy. Testosterone decanoate (250 mg) was administered intramuscularly daily for 3 days. His platelet count increased to 74 x 10(3)/microL. Maintenance therapy with testosterone once weekly for 3 weeks and then once every 3 weeks resulted in improved hematologic findings. Repeated bone marrow biopsy after 6 weeks showed normocellular marrow, with disappearance of the megakaryocytic dysplasia. The patient again discontinued his testosterone treatment, and the hematologic abnormalities recurred but were again corrected after supervised testosterone therapy.

This case emphasizes the importance of androgen replacement therapy in patients with hypopituitarism, not only for sexual potency, bone strength, and quality of life but also for normal bone marrow function.