Panhypopituitarism in two cirrhotics: clinical presentation and liver disease associations

Two cases of panhypopituitarism occurring in cirrhotic patients with chronic hepatitis C, hemochromatosis and in the second case, alpha 1-antitrypsin deficiency with phenotype SS. The hypopituitarism was most probably a result of pregnancy-associated pituitary infection in Case 1 and spontaneous infection of a somatotrophic pituitary adenoma in Case 2. Both cases experienced complications related to salt and water excretion, cardiac arrhythmia, and encephalopathy related to the pituitary disease that was initially ascribed to their hepatic disease. These two cases demonstrate the difficulty one can have in caring for patients with advanced liver disease with confounding endocrine dysfunction.