Case study shows chronic marijuana use associated with hypopituitarism
PHOENIX — Results of a case study presented here at the American Association of Clinical Endocrinologists 22nd Scientific and Clinical Congress demonstrate that smoking marijuana may result in serious endocrine complications.
According to study authors Richard Pinsker, MD, FACE, and Hineshkumar Upadhyay, MD, of Jamaica Hospital Medical Center and colleagues, a 37-year-old male demonstrated low testosterone and pituitary hormone levels associated with 15 years of daily marijuana use.
“We really feel that the evidence to-date shows this is a much more serious health problem than we’ve given credit to,” Pinsker said during a press conference. “Marijuana’s always been laughed off: ‘it’s a kid’s drug; they’ll outgrow it.’ In certain communities, it’s so common that people look at it as if they’re having a glass of beer. I think it’s time that physicians start having their antenna up for all the difficulties that come with this drug.”
The patient presented to the emergency department with dyspnea on exertion, increasing fatigue and loss of libido with no previous radiation exposure or head trauma. He had bibasilar rales, gynecomastia and bilateral atrophied testis.
His hormonal evaluation demonstrated low Luteinizing Hormone (0.2 mIU/mL); FSH (1.8 mIU/mL) and testosterone (22 ng/dL), as well as high prolactin (53.3 ng/mL).
Additionally, the patient had ACTH of 6 pg/mL and cortisol of 6.4 ug/dL at 0 minutes and 9.3 ug/dL at 60 minutes following cosyntropin administration.
Further labs revealed low total T3 (30 ng/dL); high T3 resin reuptake (49%); low total T4 (3.94 ng/dL); normal free T4 (0.97 ng/dL) and low TSH (0.22 uIU/mL). Growth hormone was within normal range (5.0 ng/mL) and IGF-I was low (75 ng/mL; Z-score of -1.3). An MRI revealed a slightly enlarged protuberant pituitary gland, but no identified mass lesion.
After being started on cortisone 25 mg in the morning and 12.5 mg at bedtime, as well as levothyroxine 25 mcg daily, the patient’s fatigue and edema improved significantly, according to the abstract.
In this case, severe hypopituitarism occurred from interference between THC, the psychoactive ingredient in marijuana which has the ability to alter neural transmitters in the hypothalamus, and hypothalamic function.
Additionally, studies show that marijuana impairs the release of gonadotropin-releasing hormone (GnRh), resulting in reduced production of testosterone.
Other symptoms seen with prolonged use include cognitive decline in school children and older people, according to Pinsker. “The public will become more attuned to looking for these things. We’re going to have what we call a surveillance bias and we’re going to start discovering that it’s a lot higher than we gave it credit for, both because of increased use and because we’re going to be looking for it.”
The authors conclude that, as many states consider the legalization of marijuana, more study should be conducted with regard to the effects of chronic use of the drug on the endocrine system.
“Of course this is one case report, but I think it should alert further research that needs to be done, “ said Pinsker. “Something prospectively should be done to map this out more scientifically, but this would be difficult in what, to-date, has been an illegal substance.”
For more information:
Pinsker R. Abstract #825. Presented at: the AACE Annual Scientific and Clinical Congress; May 1-5, 2013; Phoenix.
Disclosure: The authors report no relevant financial disclosures.