Selective Hypopituitarism

Abstract

Chronic mucocutaneous candidiasis is associated with a variety of endocrine deficiency syndromes, but hypopituitarism, to the best of our knowledge, has not been described hitherto as one of them. Two patients with candidiasis of early onset developed secondary adrenal failure due to limited adrenocorticotrophic hormone (ACTH) reserve, demonstrated by low plasma cortisol and urinary corticoid levels, ACTH stimulation, and metyrapone test. In addition, one patient showed urinary gonadotrophins (follicle stimulating and luteinizing hormones), testosterone, and plasma growth hormone deficiency. Other manifestations included idiopathic hypoparathyroidism, steatorrhea, and megaloblastic anemia. Impaired cell-mediated immunity, which characterizes chronic candidiasis, was evidenced by cutaneous anergy and severe lymphopenia. Fetal thymus transplantation was successful in immunological reconstitution in one patient, and hormone replacement therapy was effective in both.