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"Petrified ears" with idiopathic adult-onset pituitary insufficiency.

Gogate Y, Gangadhar P, Walia RR, Bhansali A - Indian J Endocrinol Metab (2012)

Bottom Line: The most common causes of this phenomenon are local trauma, frost bite, and inflammation.Adrenal insufficiency is the most frequent systemic disease associated with auricular calcification.Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, PGIMER, Chandigarh, India.

ABSTRACT
"Petrified ears" or calcification of auricular cartilage is an uncommonly reported condition. The most common causes of this phenomenon are local trauma, frost bite, and inflammation. Adrenal insufficiency is the most frequent systemic disease associated with auricular calcification. We present a case of idiopathic adult-onset pituitary insufficiency with hypocortisolism and bilateral auricular calcification. Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.

No MeSH data available.


Related in: MedlinePlus

MRI sella showing the partially empty sella
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Figure 3: MRI sella showing the partially empty sella

Mentions: A 53-year-old male presented with 6 months history of chronic diarrhea, general weakness, easy fatiguability, cold intolerance, and deterioration in mental function. He also noted that his ears were “turning to stone” in the past 1 year. He had consulted numerous physicians for this complaint but to no avail. He had no family history of neurological disorders or any other disease. Physical examination disclosed pale skin, periorbital puffiness, absent pubic hair with soft testes, and Chovstek's negative with no carpopedal spasm. His ears were generally stiff. Neurological examination revealed absent ankle jerk with extensor plantar and positive Rhomberg's sign. Biochemistry showed serum sodium 128 mEq/L, potassium 3.3 mEq/L, calcium (corrected) 7.2 mEq/L, phosphate 1.8 mEq/L, and magnesium 1.5 mEq/L with normal renal function and liver function. Endocrine work-up revealed cortisol 0.20 μg/dl (normal 5–23 μg/dl), free T3 1.67 pg/ml (normal 2.3–4.2 pg/ml), free T4 0.69 ng/dl (normal 0.7–1.51 ng/dl), TSH 5.33 (normal 0.5–5 μU/ml), positive TPO (106.3 IU/ ml), prolactin 47 ng/ml (normal 4–30 ng/ml), testosterone 76 ng/dl (normal 241–827 ng/dl) with LH 1.74 mIU/ml (normal 1.50–9.30 mIU/ml), and FSH 1.43 mIU/ml (normal 1.40–18.10 mIU/ml). There was no evidence of central diabetes insipidus (no polyuria, serum osmolality 285 mOsm/kg, urine osmolality 235 mOsm/kg). He was vitamin D insufficient with 25-hydroxy vitamin D level of 26 ng/ml (30–74 ng/ml). iPTH level was 20 pg/ml (10– pg/ml) Contrast-enhanced MRI sella revealed partially empty sella with normal stalk. Vitamin B12 levels were low–normal with a value of 311 pg/ml (normal 187–1059 pg/ml). Pernicious anemia screen was undertaken, his antiparietal cell antibody was positive, and biopsy revealed nonspecific gastritis. His serology for retroviral disease, syphilis, and rest of the autoimmune markers was negative. Non-contrast CT head revealed auricular calcification but no basal ganglia calcification. Patient also had dilated cardiomyopathy with global hypokinesia and ejection fraction of 35–40%. With this clinical and biochemical profile, a diagnosis of panhypopituitarism possibly due to adult-onset pituitary insufficiency, subacute combined degeneration, and dilated cardiomyopathy was considered. Patient was treated with IV hydrocortisone, l-thyoxine and testosterone replacement, vitamin B12 supplementation, ACE inhibitor, and beta-blocker. He experienced a rapid recovery. The patient remains well, but his ears remain unchanged [Figures 1–3].


"Petrified ears" with idiopathic adult-onset pituitary insufficiency.

Gogate Y, Gangadhar P, Walia RR, Bhansali A - Indian J Endocrinol Metab (2012)

MRI sella showing the partially empty sella
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475916&req=5

Figure 3: MRI sella showing the partially empty sella
Mentions: A 53-year-old male presented with 6 months history of chronic diarrhea, general weakness, easy fatiguability, cold intolerance, and deterioration in mental function. He also noted that his ears were “turning to stone” in the past 1 year. He had consulted numerous physicians for this complaint but to no avail. He had no family history of neurological disorders or any other disease. Physical examination disclosed pale skin, periorbital puffiness, absent pubic hair with soft testes, and Chovstek's negative with no carpopedal spasm. His ears were generally stiff. Neurological examination revealed absent ankle jerk with extensor plantar and positive Rhomberg's sign. Biochemistry showed serum sodium 128 mEq/L, potassium 3.3 mEq/L, calcium (corrected) 7.2 mEq/L, phosphate 1.8 mEq/L, and magnesium 1.5 mEq/L with normal renal function and liver function. Endocrine work-up revealed cortisol 0.20 μg/dl (normal 5–23 μg/dl), free T3 1.67 pg/ml (normal 2.3–4.2 pg/ml), free T4 0.69 ng/dl (normal 0.7–1.51 ng/dl), TSH 5.33 (normal 0.5–5 μU/ml), positive TPO (106.3 IU/ ml), prolactin 47 ng/ml (normal 4–30 ng/ml), testosterone 76 ng/dl (normal 241–827 ng/dl) with LH 1.74 mIU/ml (normal 1.50–9.30 mIU/ml), and FSH 1.43 mIU/ml (normal 1.40–18.10 mIU/ml). There was no evidence of central diabetes insipidus (no polyuria, serum osmolality 285 mOsm/kg, urine osmolality 235 mOsm/kg). He was vitamin D insufficient with 25-hydroxy vitamin D level of 26 ng/ml (30–74 ng/ml). iPTH level was 20 pg/ml (10– pg/ml) Contrast-enhanced MRI sella revealed partially empty sella with normal stalk. Vitamin B12 levels were low–normal with a value of 311 pg/ml (normal 187–1059 pg/ml). Pernicious anemia screen was undertaken, his antiparietal cell antibody was positive, and biopsy revealed nonspecific gastritis. His serology for retroviral disease, syphilis, and rest of the autoimmune markers was negative. Non-contrast CT head revealed auricular calcification but no basal ganglia calcification. Patient also had dilated cardiomyopathy with global hypokinesia and ejection fraction of 35–40%. With this clinical and biochemical profile, a diagnosis of panhypopituitarism possibly due to adult-onset pituitary insufficiency, subacute combined degeneration, and dilated cardiomyopathy was considered. Patient was treated with IV hydrocortisone, l-thyoxine and testosterone replacement, vitamin B12 supplementation, ACE inhibitor, and beta-blocker. He experienced a rapid recovery. The patient remains well, but his ears remain unchanged [Figures 1–3].

Bottom Line: The most common causes of this phenomenon are local trauma, frost bite, and inflammation.Adrenal insufficiency is the most frequent systemic disease associated with auricular calcification.Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrinology, PGIMER, Chandigarh, India.

ABSTRACT
"Petrified ears" or calcification of auricular cartilage is an uncommonly reported condition. The most common causes of this phenomenon are local trauma, frost bite, and inflammation. Adrenal insufficiency is the most frequent systemic disease associated with auricular calcification. We present a case of idiopathic adult-onset pituitary insufficiency with hypocortisolism and bilateral auricular calcification. Recognition of the association between auricular calcification and adrenal insufficiency can be an important step toward the identification of a life-threatening cortisol deficiency.

No MeSH data available.


Related in: MedlinePlus