Simultaneous occurrence of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and diabetes insipidus following pituitary apoplexy

Sasaki, Haruka; OHNISHI, Osamu; Okudera, Toshio; Okumura, Makoto

doi:10.1136/pgmj.67.783.75

Cited by 15 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Transient thyrotoxicosis was also reported to occur after cessation of steroid therapy in a patient with autoimmune thyroiditis and rheumatoid arthritis [ 12 ]. Another patient with hypopituitarism, following pituitary apoplexy, developed transient thyrotoxicosis due to painless thyroiditis (autoimmune destructive thyroiditis) [ 15 ]. Pituitary apoplexy and SS cause ACTH deficiency and secondary adrenocortical insufficiency (a cortisol decrease).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature

Takasu

Nakayama

2011

Journal of Thyroid Research

View full text Add to dashboard Cite

A 36-year-old woman with postpartum hypopituitarism (Sheehan's syndrome: SS) developed postpartum autoimmune thyroiditis (PPAT). She delivered a baby by Caesarean section (620 mL blood loss). At 1 month post partum, she developed thyrotoxicosis due to painless thyroiditis (autoimmune destructive thyroiditis). She was positive for antithyroid antibodies. Postpartum and hypoadrenalism-induced exacerbation of autoimmune thyroiditis caused the thyrotoxicosis due to autoimmune destructive thyroiditis. ACTH was undetectable. She had ACTH deficiency and secondary hypoadrenalism. Hydrocortisone was started. At 6 months post partum, she was referred to us with hypothyroidism. Thyroxine was administered. She had thyrotoxicosis at 1-2 months post partum and then hypothyroidism. She was diagnosed with PPAT. She had hypopituitarism, ACTH deficiency (secondary hypoadrenalism), low prolactin with agalactia, and low LH with failure to resume regular menses. She had empty sella on MRI. She was diagnosed with SS. Three cases with SS have been reported to develop PPAT. Postpartum immunological rebounds and hypoadrenalism-induced immunological alterations (or a combination of the two) might have been responsible for the PPAT.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Three cases with SS have been reported to develop PPAT [ 5 , 13 , 14 ]. A case with transient thyrotoxicosis due to painless thyroiditis (autoimmune destructive thyroiditis) following pituitary apoplexy was also reported [ 15 ]. Pituitary apoplexy and SS may cause secondary hypoadrenalism or a serum cortisol decrease.…”

Section: Introductionmentioning

confidence: 99%

A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature

Takasu

Nakayama

2011

Journal of Thyroid Research

View full text Add to dashboard Cite

show abstract

“…Painless thyroiditis may occur after an acute cessation of steroid therapy in patients with rheumatoid arthritis [43] or allergic rhinitis [44], after an adrenalectomy in patients with Cushing's syndrome [45], or after hypopituitarism following pituitary apoplexy [46]. Moreover, there are reports of the ACTH DEFICIENCY AND PAINLESS THYROIDITIS [47].…”

Section: Discussionmentioning

confidence: 99%

Isolated Adrenocorticotropin Deficiency Associated with Painless Thyroiditis: A Case Report and Review of the Literature

et al. 2012

View full text Add to dashboard Cite

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.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

Simultaneous occurrence of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and diabetes insipidus following pituitary apoplexy

Abstract: Summary:A rare case of concomitant association of transient thyrotoxicosis due to painless thyroiditis, hypopituitarism and central diabetes insipidus following spontaneous pituitary apoplexy is presented.

Cited by 15 publications

References 11 publications

A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature

A Patient with Postpartum Hypopituitarism (Sheehan's Syndrome) Developed Postpartum Autoimmune Thyroiditis (Transient Thyrotoxicosis and Hypothyroidism): A Case Report and Review of the Literature

Isolated Adrenocorticotropin Deficiency Associated with Painless Thyroiditis: A Case Report and Review of the Literature

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

Contact Info

Product

Resources

About