Acute-Onset Panhypopituitarism Nearly Missed by Initial Cosyntropin Testing

Table 1

Laboratory values.

Variable	Reference range, adults	One week before admission	Day 1, 10 a.m.	Day 1, 10 p.m.	Day 2	Day 3	Day 4	Day 8	Day 15	Day 32
Hematocrit (%)	36.0–45.0	0.423	0.433	0.353	0.372	0.297				0.384
Hemoglobin (g/l)	120–155 g/l	140	137	107	118	97				118
White cell count (per mm^3)	4000–10000	5700	9500	9400	6400	7000				7390
Thrombocytes (G/l)	140–400	234	287	277	292	243				306
Sodium (mmol/l)	136–146	148	139	153	147	147	151		143	144
Potassium (mmol/l)	3.6–5.0	3.6	3.9		3.8	4.3	4.2		4.3	4.3
Osmolality (mosmol/kg)	280–300		298	320			310		298
Urine osmolality (mosmol/kg)	100–1200			148	274		146	271
Urea (mmol/l)	2–7		8.1		4.6	4.9			5.7	7
Creatinine (umol/l)	53–94	61	170		120	91	83		90	55
Procalcitonin (ug/l)	<0.5	0.18	0.47		3.88
C-reactive protein mg/l	<3.0	15.8	79.2		71.3	100	47.3
Copeptin (pmol/l)	<31		4.8		2.3
Vasopressin (ADH) (pmol/l)	1.0–4.2			<0.90
TSH (mU/l)	0.4–4.0		0.14		0.05		0.07	0.1
T3 (nmol/l)	0.90–2.60				2.05		0.91
fT4 (nmol/l)	9.9–19.3						10.1	8.71
HGH (ug/l)	<7				0.23
IGF1 (ug/l)	59–195				64.7					105
FSH (U/l)	19–140				1.08					1.77
Prolactin (ug/l)	2.2–28						73.6			94.3
Morning cortisol (nmol/l)	140–700		258
Cosyntropin test (low dose)
Cortisol 0′ (nmol/l)				136				292	122	67
Cortisol 30′ (nmol/l)	>500			579				497	356	219