INTRODUCTIONAlthough isolated adrenocorticotropin (ACTH) deficiency (IAD) is a heterogeneous disorder with several etiologies, the majority of acquired cases are most likely due to an autoimmune process [1][2][3]. Painless thyroiditis, which is considered a variant form of Hashimoto's thyroiditis, is characterized by transient thyrotoxicosis that is sometimes followed by transient hypothyroidism and then recovery [4]. Although acquired IAD is not uncommonly associated with other autoimmune endocrine disorders, especially Hashimoto's thyroiditis [5,6], reported cases of IAD associated with painless thyroiditis are scarce. Herein, we report a case of IAD associated with painless thyroiditis and briefly review the literature. CASE REPORTA 53-year-old Japanese man was admitted to hospital with a 3-month history of transient headache followed by general fatigue, weight loss of 4 kg and myalgia. He had a history of ocular myasthenia gravis which had been in remission following thymectomy 30 years prior to admission. He had no family history of endocrine or autoimmune disorders. On admission, he was 157 cm in height and weighed 47 kg. His blood pressure was 108/68 mmHg, pulse was regular at 92 beats/min, and his temperature was 37.1℃. Ophthalmologic examinations, including visual acuity, visual field and ocular fundus revealed no abnormalities. A small diffuse goiter was palpable without tenderness. The heart, lungs and abdomen were not remarkable. The relaxation phase of the Achilles ten- Kurume Medical Journal, 59, 71-77, 2012 Summary: A 53-year-old Japanese man was admitted with a 3-month history of transient headache followed by general fatigue and weight loss. He had a history of ocular myasthenia gravis which had been in remission following thymectomy 30 years ago. He had a small diffuse goiter without tenderness, and was diagnosed as having painless thyroiditis with mild thyrotoxicosis on admission. Endocrinological studies showed he had isolated adrenocorticotropin deficiency. Magnetic resonance imaging of the pituitary gland revealed no abnormalities. His symptoms improved soon after replacement of glucocorticoid. After an episode of hypothyroidism, he spontaneously became euthyroid. It is likely that thyrotoxicosis uncovered adrenal insufficiency that had developed insidiously, and hypoadrenocorticism-induced immunological changes may have triggered the development of painless thyroiditis. Moreover, thymectomy might have facilitated the development of pituitary and thyroid autoimmunity.

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This paper reports on the control system that drives the Direet日 ectromagnetic Ventricular Assist Device ( DEM ・ VAD ｝ which is currently under devdopment ． DEM − VAD driven by Linear Osci 睚 atory Ac 腰 a 龜 or ( LOA ) has the structure ， which makes the pusher − plate a匡 tached to the Mover reciprocate directly 」 The princlpal feature of our LOA is that the thrust generaヒ ed by the same input eleCtric power dif 「 ers accordlng to the positions and the drive directions of the mover ． The mover consists of permanent magnets ， 匙 herefore in order to generate the control slgnal according to the pusher − plate pos 綻 ion and the drive direction ， the informatb 渦 on the pos 撮on detected by the hal l sensor was used ． As a result of driving a pump in a mock circulatory system ， the maximum pu 閉 p rate in which ful 田 1 ト full elect drive was possible were 167bpm in drive voltage 10V ( A 髄erload 重00mmHg ， Preload 10mmHg ) ． At this time， input power was 8． 5W ， pump output was 7． 2 L！ min ， and e 爾 ciency was 18． 9％ ． We tried to control the obstru 〔 距ion of the pump inlet occurred using change of slope of the ha ｝ l sensor output voltage wave 董 orm ． Consequently， the possibility was suggested σ f removing t轟e obstruction of the pump inlet which occurred ．