Thread by @omlakhani

What is "auto-hypophysectomy' ? A #Tweetorial

This is an interesting phenomenon seen in endocrinology. I will illustrate the same with a case

An elderly gentleman (non-diabetic) presented to the ER with recurrent hypoglycemia and hyponatremia

On evaluation, we found the patient suffered from Panhypopituarism leading to Adrenal insufficiency, Central hypothyroidism etc

This all this time that we were saving his life, we did not 'see' the patient . I mean really 'see' the patient

In the morning rounds today, when the patient was really better, I 'saw' the patient. Lo behold, the patient looked "Acromegaloid"

Here comes the time when THE ENDOCRINOLOGIST stops everything and tries to go back on time. Out comes the mobile phone with old photos. And then older photos. "Gosh, I am right. The patient DID have acromegaly some time in his life

But nature is great, it cured it without surgery ! An auto-hypophysectomy'

This curious term is used by Salam Ranabir and Manash P. Baruah in their review article on 'Pituitary apoplexy'

ncbi.nlm.nih.gov/pmc/articles/P…

Basically, a highly vascular pituitary tumor bleeds, sometimes slowly to basically automatically cure the tumor and render the patient in a hypopit state only to be picked up by a keen endocrinologist at a later date. This ladies & gentleman's nature's own Pituitary surgeon.

This is perhaps a slow subclinical bleed

"Subclinical pituitary apoplexy” is widely used to describe pathological evidence of asymptomatic pituitary ischemia or hemorrhage" to quote Dr. Ranbir

The functional pituitary tumor like acromegaly naturally becomes non-functional leading to an automatic cure

End of #tweetorial , thanks for reading. @IndiaESI @SanjayKalraDr1 @Unnikri @monty_doc @DrSunil_Kota @Pituitary_org @pituitaryorg @providenceendo @j_metb @TheEndoSociety @EsePresident

@drtejallathia @DrAish_Krish @ChitraEndocrine @belindageorge