Wepresent here a case of prominent hypercalcemia accompanied by hypothalamic tumor and Graves' disease. A24-year-old manwith hypothalamic tumor showed hypopituitarism, central diabetes inspidus (DI) and hyperthyroidism. Nausea, loss of thirst and appetite, and general fatigue were found with the unveiling of hypercalcemia and hypernatremia. Parathyroid hormone (PTH) and la-dihydroxyvitamin D levels were suppressed with a normal range of PTHrelated protein values. One-desamino-(8-D-arginine)-vasopressin (DDAVP)and half-saline administration normalized hypernatremia, while hypercalcemia was still sustained. Administration of cortisone acetate and thiamazole reduced the elevated serum Ca level. In the present case, concurrent hyperthyroidism was assumed to accelerate skeletal mobilization of calcium into the circulation. Hypocortisolism and central DI was also considered to contribute, to some extent, to the hypercalcemia through renal handling of Ca. (Internal Medicine 38: 486-490, 1999)

Wepresent here a rare case of hypopituitarism accompanied by growth hormone (GH) deficiency and hypogonadotropic hypogonadism, in which the patient attained normal height but was of eunuchoid appearance. A 23-year-old man whohad not reached puberty was referred to Saitama Medical School for hormonal evaluation. Basal hormonal data and hormone-stimulating tests revealed impaired secretion of GH,gonadotropins and adrenocorticotropic hormone (ACTH).Serum levels of testosterone, estrone, estradiol and estriol were all below the detectable ranges. The patient's plasma ACTHresponded to corticotropin releasing hormone, but not to insulin-induced hypoglycemia. Serum GHshowed a minimal response to GHreleasing hormone, but was unresponsive to insulin-induced hypoglycemia. Serum luteinizing hormone and follicle stimulating hormone did not respond to luteinizing hormone-releasing hormone. The results were compatible with a diagnosis of hypothalamic hypopituitarism. Magnetic resonance images of the brain showeda small anterior pituitary, an ectopic posterior lobe and transection of the pituitary stalk. Although the patient showed signs of hypopituitarism, he finally attained normal height, possibly because of failed epiphyseal maturation. His bone mineral density was markedly reduced to 0.647 g/cm2 in the lumbar spine; this level was 61.7 % of the average level of healthy youngmales. Our findings were compatible with a recently advocated view that estrogen is important in promoting epiphyseal fusion and in determining bone density in males as well as females. (Internal Medicine 39: 641-645, 2000)

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