Hypercalcemia Accompanied by Hypothalamic Hypopituitarism, Central Diabetes Inspidus and Hyperthyroidism.

Wada, Seiki; Kurihara, Susumu; Imamaki, Keiji; Yokota, Keisuke; Kitahama, Shinji; Yamanaka, Kayo; Itabashi, Akira; Iitaka, Makoto; Katayama, Shigehiro

doi:10.2169/internalmedicine.38.486

Cited by 9 publications

(8 citation statements)

References 16 publications

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“…Excess thyroid hormone stimulates bone resorption, which is partially inhibited by cortisol (23,24). There have been some case reports of patients who concomitantly exhibited adrenal insufficiency and thyroid disorders, such as thyrotoxicosis (12,(25)(26)(27) and hypothyroidism (28,29). However, in this study, there was no patient under immobilization or who had thyroid dysfunction before the onset of hypercalcemia.…”

Section: Discussionmentioning

confidence: 60%

Clinical Manifestation of Hypercalcemia Caused by Adrenal Insufficiency in Hemodialysis Patients: A Case-series Study

et al. 2014

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Objective The goal of this study was to clarify the clinical manifestation of hypercalcemia due to hypoadrenalism in hemodialysis (HD) patients. Methods We retrospectively analyzed the clinical characteristics of five HD patients who had presented with hypercalcemia due to adrenal insufficiency (age: 69±7 [58-75] years old, time on HD: 13±11 [2-32] years). We conducted corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) stimulation tests. We also examined serum bone turnover markers before and after glucocorticoid replacement. Results All patients had critical illnesses at the onset of hypercalcemia. They had at least one symptom, such as eosinophilia, hypoglycemia, or fever. The prevalence of hypercalcemia due to adrenal insufficiency was 1.3% in maintenance HD patients on admission. The causes of adrenal insufficiency were isolated ACTH deficiency, pituitary apoplexy, pituitary atrophy, glucocorticoid withdrawal syndrome, and unilateral adrenalectomy. Serum calcium (Ca) levels corrected by serum albumin were maximally increased to 12.9 to 14.3 mg/dL in four anuric HD patients and mildly elevated to 10.4 mg/dL in a patient with residual diuresis. Their basal serum cortisol levels ranged from <1.0 to 15.4 μg/dL. Single CRH injections failed to increase serum cortisol in any of the patients. Glucocorticoid replacement acutely normalized serum Ca and decreased levels of carboxy-terminal telopeptide of type I collagen, a marker of bone resorption. Conclusion Adrenal insufficiency could therefore be an occult cause of hypercalcemia in anuric HD patients who are critically ill.

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Section: Discussionmentioning

confidence: 60%

Clinical Manifestation of Hypercalcemia Caused by Adrenal Insufficiency in Hemodialysis Patients: A Case-series Study

et al. 2014

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“…In another case report, a 24-year-old male patient presenting with hypercalcemia and hypernatremia was diagnosed with hypopituitarism, diabetes insipidus and GD. [16] More recently, the potential coexistence of TSH-secreting pituitary adenomas and autoimmune hypothyroidism, [17] GD and macroprolactinoma [18] and GD and lymphocytic hypophysitis has been reported. [19,20] In cases of acromegaly, the presence of goiter is 59.2%; however, overt hyperthyroidism develops in 8.6% of patients.…”

Section: Discussionmentioning

confidence: 99%

Sheehan′s syndrome co-existing with Graves′ disease

Arpacı¹,

Çuhacı

Sağlam

et al. 2014

Niger J Clin Pract

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Sheehan's syndrome (SS), which is an important cause of hypopituitarism, is common in developing countries. The most common presentation is the absence of lactation and amenorrhea. Hypothyroidism rather than hyperthyroidism is the usual expected phenomenon in SS. Postpartum hyperthyroidism is also common and Graves' disease (GD) is an important cause of postpartum hyperthyroidism. Here we report a case of a 22-year-old female patient in our clinic presented symptoms of amenorrhea, lack of lactation, palpitations and sweating. Her physical examination revealed goiter, moist skin and proptosis. Her laboratory evaluation showed suppressed thyroid stimulating hormone, elevated levels of free thyroxine and free triiodothyronine. Thyroid antibodies were positive. Tec 99m thyroid scintigraphy results were gland hyperplasia and increased uptake consistent with GD. She gave birth 7 months ago; after delivery she had a history of prolonged bleeding, amenorrhea and inability to lactate. She had hypogonadotropic hypogonadism, hyperprolactinemia and growth hormone deficiency. Serum cortisol and adrenocorticotropic hormone levels were normal. Her magnetic resonance imaging was empty sella. Our diagnosis was GD co-existing with SS. GD with concomitant hypopituitarism is rare but has been described previously, but there are no reports of GD occurring with SS. In this case study, we report a patient with GD associated with SS.

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“…Maruyama et al (16) reported that transient thyrotoxicosis developed after cessation of steroid therapy in a patient with autoimmune thyroiditis and rheumatoid arthritis, and plasma cortisol concentration was 6.7 μg/dL when thyrotoxicosis developed. Wada et al (17) reported the simultaneous occurrence of hyperthyroidism and ACTH deficiency due to a hypothalamic tumor. Takasu et al (18) reported that there were exacerbations of autoimmune thyroid dysfunction during the period of glucocorticoid tapering after unilateral adrenalectomy in patients with adrenal Cushing's syndrome.…”

Section: Discussionmentioning

confidence: 99%

“…Neurologic examinations revealed no abnormalities. Laboratory findings were as follows: white blood cells 5,900/mm 3 (reference range: 4,300-10,800), blood urea nitrogen 18.4 mg/dL (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), creatinine 0.7 mg/dL (0.5-1.3), sodium 135 mEq/L (136-146), potas- -20). The urine volume was 1,800 mL/day.…”

Section: Case Reportmentioning

confidence: 99%

Transient Thyrotoxicosis Accompanied by Panhypopituitarism Caused by Ruptured Rathke's Cleft Cyst

et al. 2011

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We describe a rare case of transient thyrotoxicosis secondary to painless thyroiditis accompanied by panhypopituitarism caused by ruptured Rathke's cleft cyst. A 32-year-old man presented with vomiting and diarrhea. Laboratory data showed that he had transient hypercalcemia, primary thyrotoxicosis due to painless thyroiditis and panhypopituitarism. The sellar magnetic resonance imaging showed cystic macroadenoma. He underwent surgical exploration. Histological examination showed a ruptured Rathke's cleft cyst. Our case suggests that, although rare, it is important to recognize the possibility of coexistence of hypopituitarism in patients with primary thyrotoxicosis.

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Hypercalcemia Accompanied by Hypothalamic Hypopituitarism, Central Diabetes Inspidus and Hyperthyroidism.

Cited by 9 publications

References 16 publications

Clinical Manifestation of Hypercalcemia Caused by Adrenal Insufficiency in Hemodialysis Patients: A Case-series Study

Clinical Manifestation of Hypercalcemia Caused by Adrenal Insufficiency in Hemodialysis Patients: A Case-series Study

Sheehan′s syndrome co-existing with Graves′ disease

Transient Thyrotoxicosis Accompanied by Panhypopituitarism Caused by Ruptured Rathke's Cleft Cyst

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