Panhypopituitarism: A Case Report of a Rare Complication of Cerebral Venous Thrombosis Secondary to Ulcerative Colitis

Cerebral venous sinus thrombosis (CVST) is a recognised but uncommon thrombotic complication of ulcerative colitis (UC).Hypothalamic-pituitary dysfunction, specifically panhypopituitarism following extensive cerebral venous thrombosis, has been rarely documented.We report a case of a 21-year-old gentleman with a background of recently diagnosed UC.On his first admission, he developed symptoms suggestive of CVST, which required intensive therapy unit (ITU) admission and was later discharged.Four months later, he was re-admitted due to a severe UC flare resulting in toxic megacolon, requiring a subtotal colectomy and further ITU admission.During the course of his admission, he developed polyuria, hypernatraemia, raised plasma osmolality, recurrent hypoglycaemia, and hypogonadism.Upon endocrine consultation, the assessment concluded that there was evidence of anterior and posterior pituitary dysfunction in keeping with panhypopituitarism.He was treated with hydrocortisone, levothyroxine, desmopressin, and testosterone replacement.A follow-up pituitary MRI later showed appearances consistent with empty sella.Overall, this case highlights two important considerations.Firstly, early recognition of CVST is needed in patients with neurological symptoms and active UC.Secondly, pituitary dysfunction should be considered in patients with UC who develop extensive CVST alongside persistently unexplained hypoglycaemia, polyuria, hypernatraemia, or hyperosmolality.