RESUMEN
We describe a young woman with lymphocytic hypophysitis presenting in the early post-partum period. She had selective corticotroph failure causing secondary adrenal insufficiency. At the time of presentation she had transient hyperthyroidism due to thyroiditis, and hypercalcaemia. This is the third case to be described of hypercalcaemia occurring in association with lymphocytic hypophysitis. Hypercalcaemia is not a recognized complication of other forms of pituitary failure. The two previously described cases also had selective corticotroph failure and hyperthyroidism due to thyroiditis. This pattern of presentation supports the concept that thyroid hormone action in the presence of glucocorticoid deficiency is responsible for the increased calcium efflux from bone into the circulation. Reduced renal excretion of calcium due to a reduction in calcium delivery to the glomerulus and increased proximal tubular reabsorption are also implicated in the aetiology of hypercalcaemia associated with adrenal failure.
Asunto(s)
Insuficiencia Suprarrenal/complicaciones , Hipercalcemia/etiología , Hipotiroidismo/etiología , Enfermedades de la Hipófisis/complicaciones , Trastornos Puerperales/etiología , Adulto , Femenino , Humanos , Embarazo , Tiroiditis/complicacionesRESUMEN
A 76-year-old man with fasting hypoglycaemia had impaired in-vitro binding of insulin to erythrocyte receptors. The immunoglobulin fraction of his plasma inhibited binding of insulin to normal donor erythrocytes in vitro. Autoantibodies may have stimulated the insulin receptor and produced hypoglycaemia. Hodgkin's disease developed and may have induced the autoimmunity. The hypoglycaemia did not respond to plasmapheresis or azathioprine alone, but it remitted after the addition of prednisolone, and the erythrocyte receptor binding of insulin became normal.