Hypopituitarism Possibly due to Lymphocytic Hypophysitis in a Patient with Type 1 Diabetes

Matoba, Keiichiro; Mitsuishi, Sumie; Hayashida, Satoshi; Yamazaki, Hiroyuki

doi:10.2169/internalmedicine.53.2158

Cited by 6 publications

(7 citation statements)

References 12 publications

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“…The phenomenon was rarely reported thereafter. Several studies showed that panhypopituitarism due to pituitary hemorrhage/infarction (including Sheehan's syndrome) induced a remarkable reduction of insulin doses in patients with type 1 diabetes [3,4,13,14]. A complete amelioration of diabetes induced by adrenal insufficiency was reported in patients with type 2 diabetes [5], but it has never been reported in a patient with type 1 diabetes with decreased insulin secretory capacity to an insulindependent level as observed in our patient.…”

Section: Discussioncontrasting

confidence: 53%

“…Glucocorticoids increase blood glucose levels by increasing hepatic gluconeogenesis and inhibiting the uptake and utilization of glucose in peripheral tissues. Glucocorticoid deficiency can lead to an amelioration of glycemic control and/or a reduction of the insulin dose in patients with diabetes [2][3][4][5], but it is unclear whether the hyperglycemia in type 1 diabetes could be ameliorated without insulin treatment when complicated with adrenal insufficiency. Here, we describe the case of a patient who latently developed type 1 diabetes with endogenous insulin deficiency concurrently with adrenal insufficiency due to autoimmune hypophysitis.…”

Section: Adrenocorticotropic Hormone (Acth)mentioning

confidence: 99%

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Masked type 1 diabetes mellitus (T1DM) unveiled by glucocorticoid replacement: a case of simultaneous development of T1DM and hypophysitis in an elderly woman

et al. 2020

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As a rare condition characterized by inflammation of the pituitary gland, hypophysitis usually results in hypopituitarism and pituitary enlargement. The most critical outcome of hypopituitarism is caused by secondary adrenal insufficiency. Glucocorticoid deficiency is a life-threatening condition, and patients who develop this deficiency require prompt diagnosis and treatment. However, a delayed diagnosis of hypopituitarism may occur due to its non-specific clinical manifestations. A common presenting sign of glucocorticoid deficiency is hypoglycemia. The amelioration of hyperglycemia has been observed in diabetic patients with adrenal insufficiency. We report the case of a 70-year-old Japanese woman who had suffered from fatigue and anorexia for several months; she was admitted based on refractory hyponatremia (sodium 125-128 mEq/L) and hypoglycemia (glucose 58-75 mg/dL). Laboratory findings and magnetic resonance imaging findings led to the diagnosis of panhypopituitarism caused by autoimmune hypophysitis. After receiving 10 mg/day of hydrocortisone, the patient developed severe hyperglycemia (glucose >500 mg/dL). Undetectable C-peptide levels and positive results of both insulinoma-associated antigen-2 antibodies and insulin autoantibodies indicated that she had experienced a recent onset of type 1 diabetes. The pathophysiological process indicated that overt hyperglycemia could be masked by the deficient action of glucocorticoids even in a diabetic patient with endogenous insulin deficiency. This uncommon case reinforces the importance of the prompt diagnosis and treatment of hypopituitarism. Clinicians should remain aware of the possibility of hidden diabetes when treating hypoglycemia in patients with adrenal insufficiency.

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Section: Discussioncontrasting

confidence: 53%

Section: Adrenocorticotropic Hormone (Acth)mentioning

confidence: 99%

Masked type 1 diabetes mellitus (T1DM) unveiled by glucocorticoid replacement: a case of simultaneous development of T1DM and hypophysitis in an elderly woman

et al. 2020

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“…Hence, our patient's findings corresponded to a suspected case of lymphocytic hypophysitis according to the relevant diagnostic criteria. [1]…”

Section: Discussionmentioning

confidence: 99%

“…Hypopituitarism is a rare condition that may present as recurrent severe hypoglycemia and can influence the glycemic profile of patients with type 1 diabetes. [1,2] However, hypopituitarism often develops insidiously, [1] the diagnosis of hypopituitarism still remained challenging and often delayed by several months. In the present case report, we aimed to demonstrate the uncommon association of hypoglycemia, hyponatremia, and gastrointestinal symptoms with hypopituitarism in a female patient with type 1 diabetes.…”

Section: Introductionmentioning

confidence: 99%

Severe hypoglycemia and hyponatremia caused by hypopituitarism in a female patient with type 1 diabetes

Zheng

Qiu²,

H³

2019

Medicine

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Rationale: The misdiagnosis of hypopituitarism is common due to its rarity and its nonspecific clinical manifestations. Our case report highlights the importance of critical evaluation regarding hypopituitarism as a cause of recurrent hypoglycemia, hyponatremia, and gastrointestinal symptoms in patients with T1DM, as misdiagnosis might be fatal to the patient. Patient concerns: We herein report the case of 35-year-old female patient who presented with 18 years of history of well-controlled type 1 diabetes mellitus and a 6-month history of recurrent nausea and vomiting, generalized weakness, hyponatremia, and severe hypoglycemia, despite a reduction in the dose of insulin. She was considered as having “type 1 diabetes and gastroparesis.” Four months later, she was diagnosed with hypothyroidism, and 25 μg/d of levothyroxine was prescribed. However, the levothyroxine had to be discontinued 1 week later because of frequent vomiting by the patient. Diagnosis: Further evaluation in our hospital revealed low-normal adrenocorticotropic hormone, low-normal serum cortisol, and low 24-hours urinary cortisol excretion. Secondary hypothyroidism and hypogonadotropic hypogonadism were also demonstrated. Based on the endocrinological findings, she was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis. Diabetic nephropathy was another diagnosis made after kidney biopsy. Interventions: The patient was treated with 100 mg/d of hydrocortisone intravenously for 2 weeks. After that, she continued on 15 mg/d of prednisone, and then 25 μg/d of levothyroxine was administered. Outcomes: The patient's insulin requirement increased to a premorbid level, the severe hypoglycemia resolved, the physical discomforts were alleviated, and blood electrolytes returned to normal. Lessons: This uncommon case reinforced the significance of a timely diagnosis and appropriate treatment of hypopituitarism. We recommend that physicians focus their awareness on this potentially life-threatening disease, as it is a condition potentially fatal to the patient if not recognized and treated.

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“…Magnetic Resonance Image (MRI) is characterized by symmetric enlargement of the pituitary stalk or pituitary gland, with a strong homogeneous gadolinium enhancement. The definitive diagnosis would be given by histopathology if available [8].…”

mentioning

confidence: 99%

Partial Central Adrenal Insufficiency Due to Possibly Autoimmune Hypophysitis, Misdiagnosed as Depression

Chávez-Díaz¹,

Zapatero-Larrauri²

2016

CSMC

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Hypopituitarism Possibly due to Lymphocytic Hypophysitis in a Patient with Type 1 Diabetes

Cited by 6 publications

References 12 publications

Masked type 1 diabetes mellitus (T1DM) unveiled by glucocorticoid replacement: a case of simultaneous development of T1DM and hypophysitis in an elderly woman

Masked type 1 diabetes mellitus (T1DM) unveiled by glucocorticoid replacement: a case of simultaneous development of T1DM and hypophysitis in an elderly woman

Severe hypoglycemia and hyponatremia caused by hypopituitarism in a female patient with type 1 diabetes

Partial Central Adrenal Insufficiency Due to Possibly Autoimmune Hypophysitis, Misdiagnosed as Depression

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