Secondary Adrenal Failure Research Articles

Normal cortisol response to corticotropin in patients with secondary adrenal failure

Normal cortisol response to corticotropin in patients with secondary adrenal failure

Selective Hypopituitarism

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.

Selective hypopituitarism. Impaired cell-mediated immunity and chronic mucocutaneous candidiasis.

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.

Selective Extrapontine Myelinolysis in Osmotic Demyelination Syndrome in a Case of Previously Undiagnosed Sheehan's Syndrome with Recurrent Hyponatraemia - A Rare Association

Selective extrapontine myelinolysis (EPM) following a marked change in osmolarity, usually due to the rapid correction of hyponatraemia. Association of EPM in hyponatraemia from Sheehan's syndrome is very rare. We report a 38 years old lady with EPM, who presented with repeated attacks of hyponatraemia for 2 years, which were corrected several times after hospital admissions. She has got history of postpartum haemorrhage about 10 years back followed by secondary amenorrhoea and lactational failure. At present she came to us with features of parkinsonism, dystonia, mutism, insomnia and emotional outburst. Her magnetic resonance imaging (MRI) of the brain revealed features of myelinolysis with atrophied pituitary gland. Her serum pituitary hormonal levels confirm presence of hypopituitarism with secondary adrenal failure due to Sheehan's syndrome. Now her present features are due to selective extrapontine myelinolysis of osmotic demyelination, might be due to any episode of inappropriate intravenous correction of hyponatraemia. Keyword: Sheehan's syndrome; Hyponatraemia; Extrapontine myelinolysis; Osmotic demyelination syndrome DOI: 10.3329/jom.v12i1.6936J Medicine 2011; 12 : 77-80

Sheehan's syndrome (postpartum panhypopituitarism); report of a case and comment on clinical management.

A CASE of Sheehan's syndrome (postpartum panhypopituitarism) is presented, with observations on treatment. The patient showed evidence of secondary thyroid, adrenal, and gonadal failure. Combined stimulation and replacement therapy restored the patient to health. Mrs. E. H., age 44, was admitted to St. Joseph's Hospital, Vancouver, Wash., on Oct. 10, and was discharged on Nov. 8, 1952. The chief complaints, as given by the patient's mother, were nausea and vomiting, drowsiness, extreme weakness, and mental confusion. The present illness began about five months before admission, when the patient's mother noted that she was becoming irritable, was easily upset by small troubles, and had a capricious appetite. She had always been good natured before this time. Her dentist had refused to extract her carious teeth unless she would take thyroid and iron; thyroid had been advised a year before but the patient had taken it very haphazardly and finally stopped taking