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Hypothalamic-hypopituitarism due to temporal arteritis.

G D Everett, J M Amatruda, P D Woolf

    Archives of Internal Medicine
    |April 1, 1979
    PubMed
    Summary
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    Temporal arteritis can cause hypothalamic hypopituitarism, affecting hormone levels. This case highlights a rare complication, possibly due to rich blood supply in the brain region.

    Area of Science:

    • Endocrinology
    • Neurology
    • Rheumatology

    Background:

    • Temporal arteritis (giant cell arteritis) is a systemic vasculitis affecting medium and large arteries.
    • Intracranial involvement in temporal arteritis, while known, rarely impacts the hypothalamus and pituitary gland.
    • Hypopituitarism is a potential endocrine complication of various systemic diseases.

    Observation:

    • A 74-year-old woman with active temporal arteritis developed symptoms of hypopituitarism.
    • Hormonal assays revealed low basal levels of gonadotropins, thyroxine, and thyroid-stimulating hormone.
    • Impaired responses of growth hormone and prolactin to stimuli (insulin hypoglycemia, chlorpromazine) confirmed hypopituitarism.

    Findings:

    • The hypothalamic origin of hypopituitarism was indicated by normal prolactin and gonadotropin responses to gonadotropin-releasing hormone and thyrotropin-releasing hormone administration.

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  • This case represents a rare instance of hypothalamic-pituitary dysfunction in the context of temporal arteritis.
  • The pituitary gland and hypothalamus appear relatively protected from ischemic injury in temporal arteritis.

    • Implications:

    • The findings suggest that the rich vascularization of the hypothalamic-pituitary axis may confer some protection against ischemic damage in temporal arteritis.
    • Understanding these mechanisms is crucial for diagnosing and managing endocrine complications in patients with vasculitis.
    • Further research into the vascular dynamics of the hypothalamic-pituitary region in inflammatory conditions is warranted.