Amyloidosis associated with pituitary function abnormalities

A 54-year-old male patient, known case of plasma cell proliferative disorder (PCPD), was referred from the hematology department for abnormal thyroid function (TSH – 1.78 mcIU/mL, T4 – <12 nmol/L, T3 – 0.62 nmol/L). This abnormal thyroid function was suggestive of secondary hypothyroidism. Also, the adrenocorticotropic hormone (ACTH) stimulated cortisol (60 min post-ACTH (235 nmol/L) response was inadequate. This suggested multiple anterior pituitary hormone deficiencies. Accompanying this was the complaint of enlargement of the tongue over one year [Figures 1 and 2]. Consequently, there was difficulty in speaking, eating, and a changed voice. A tongue biopsy was performed to rule out malignancy. It came out to be amyloidosis. Because the patient had amyloidosis along with multiple pituitary hormone deficiencies, magnetic resonance imaging (MRI) was performed, which showed hypo-intensity in the central part of the anterior pituitary, suggestive of amyloid deposition in the pituitary [Figure 3]. Hence, taking the presence of PCPD in conjunction with the MRI and biopsy-proven amyloid deposit in the tongue, a diagnosis of pituitary amyloidosis was established.Figure 1: MacroglossiaFigure 2: This sagittal T1-weighted magnetic resonance imaging highlights macroglossia, with significant enlargement of the tongue, evident by its increased volume and altered anatomy. The imaging provides structural details consistent with macroglossia’s clinical presentationFigure 3: This T1-weighted magnetic resonance imaging of the pituitary shows central hypo-intensity in the anterior pituitary, suggestive of amyloid deposition. The pituitary gland appears slightly smaller in size, and the stalk is normal without significant thickening or deviationFinancial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.