Virginia Via Research Day Book 2026

Medical Resident Research Case Reports

21 PITUITARY PERILS: SECONDARY HYPOPITUITARISM

Maria Shamsi, MD; Cletus Atta, MD; Armand Ngassam, MD; Comlavi Tossou, MD; Eric O'Neal, MD; Pavitra Balasubramanian, MD; Kimberly Bird, MD Corresponding author: Maria.Shamsi@LPNT.net

Sovah Health - Danville, Danville, Virginia

the patient was discharged on fludrocortisone 0.1 mg daily, levothyroxine 25 mcg daily, hydrocortisone 5 mg daily, and testosterone cypionate 200 mg intramuscularly every 14 days. Upon discharge, the patient was discharged to a skilled nursing facility with multidisciplinary follow-up with Endocrinology and Nephrology. Comments: The phenomenon behind hypopituitarism offers a plethora of differential diagnoses, and it is important to initiate a thorough investigation for hypoglycemia and other fatal conditions. Recurrent hypoglycemia can occur in the setting of secondary adrenal insufficiency, which requires prompt treatment with corticosteroid therapy, with hydrocortisone being first line. In 1931, Bernado Houssay discovered the Houssay Phenomenon, which explains that hypoglycemia is seen in patients who have anterior pituitary dysfunction, which can help resolve diabetes. For our patient, his clinical presentation and his history of a traumatic brain injury warranted a thorough endocrine workup. In addition, other causes for hypoglycemia should be ruled out, including testing for insulin antibodies, hepatic/renal failure, alcohol intake, stressors, and assessing neoplasms. Our patient had an additional hospitalization in August 2025 and

was provided with additional services from the hospital to optimize his medication regimen. Recurrent hypoglycemic episodes warrant a meticulous workup, including ruling out hypopituitarism and other fatal causes. In addition, secondary hypopituitarism carries a high threshold of fatality that requires close monitoring and an interdisciplinary team for optimal recovery. Diagnosis: Secondary hypopituitarism, complicated by recurrent hypoglycemic episodes, with a history of a traumatic brain injury Reference: [1] Rizwan, T., Arora, G., Alachalbi, M., Quershi, F. Hypopituitarism Presenting as Recurrent Episodes of Hypoglycemia: Houssay Phenomenon. Cureus 2023 Apr; 15(4);e37530.

Context: Hypopituitarism is a rare phenomenon that involves a decrease in production and secretion of pituitary hormones, with a high threshold to become life-threatening. The incidence of this condition is 4.2 per 100,000 per year and the prevalence is 45.5 per 100,000. Primary causes include pituitary tumors, non tumoral, and extra-pituitary tumors. Report of Case: We present a 57-year-old male who initially presented to the hospital for persistent hypoglycemia and severe hypovolemic hypochloremic hyponatremia. He was previously seen at our facility for persistent hypoglycemic episodes, with an insulinoma workup being unremarkable. In addition, he was noncompliant with his steroid replacements and appetite stimulation medications at home. Imaging revealed the following: Empty sella turcica with stable encephalomalacia and gliosis of the inferior left frontal lobe and bilateral occipital lobes from his remote traumatic brain injury. Further workup revealed suboptimal levels of all endocrine hormones released from the anterior pituitary gland. He initially was on D10 IV, which gradually weaned down; his home steroid replacements were re-initiated, and appetite stimulation was re-initiated. The patient's clinical presentation slowly began to improve, and

Table of Contents

152 Edward Via College of Osteopathic Medicine (VCOM)