Abstract
A 45-year-old man with type I diabetes mellitus of 25-yr duration and well controlled by conventional insulin therapy developed an isolated adrenocorticotropic hormone (ACTH) deficiency. He presented with a 3-month history of weight loss, weakness, anorexia and persistent tendency to hypoglycemia that he had never experienced before. Basal and dynamic endocrine testing disclosed absent Cortisol secretion caused by an isolated ACTH deficiency due to a primary pituitary defect. Corticosteroid replacement therapy allowed again a good glycometabolic control. The possible causes of hypoglycemia in insulin-treated diabetes and the pathogenetic basis of the reported association are discussed.
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Bolli G.B., De Feo P., De Cosmo S., Perriello G., Ventura M.M., Massi Benedetti M., Santeusanio F., Gerich J.E. A reliable and reproducible test for adequate glucose counterregulation in type I diabetes mellitus. Diabetes 33: 732, 1984.
Boden G., Reichard G.A. Jr., Hoeldke R.D., Rezvani I., Owen O.E. Severe insulin-induced hypoglycemia associated with deficiencies in the release of counterregulatory hormones. N. Engl. J. Med. 305: 1200, 1981.
Carpenter C.G.J., Solomon N., Silverberg S.G., Bledsoe T., Northcutt R.C., Klinenberg J.R., Benett I.L., Harvey A.M. Schmidt’s syndrome (thyroid and adrenal insufficiency): a review of the literature and a report of fifteen new cases including ten instances of coexistent diabetes mellitus. Medicine (Baltimore) 43: 153, 1964.
Niakan E., Harati Y., Comstock J.P. Diabetic autonomic neuropathy. Metabolism 35: 224, 1986.
Stacpoole P.W., Interlandi J.W., Nicholson W.E., Rabin D. Isolated ACTH deficiency: a heterogeneous disorder. Medicine (Baltimore) 61: 13, 1982.
Lefebvre J.P., Luyckx A.S. Hypoglycemia. In: Ellenberg M., Rifkin H. (Eds.), Diabetes Mellitus: Theory and Practice. Mc Graw-Hill, New York, 1983, p. 988.
Abramson E.A., Arky R.A. Coexistent diabetes mellitus and isolated ACTH deficiency: report of a case. Metabolism 17: 492, 1968.
Kojima I., Nejima I., Ogata E. Isolated adrenocorticotropin deficiency associated with polyglandular failure. J. Clin. Endocrinol. Metab. 54: 182, 1982.
Sandler R., Proudfoot G.R. Isolated ACTH deficiency contributing to frequent hypoglycemia in type I diabetes. Diabetes Care 8: 302, 1985.
Wieland R.G., Wieland G.M. Isolated adrenocorticotropic hormone deficiency with antepartum pituitary infarction in type I diabetic. Obstet. Gynecol. 65: 58S, 1985.
Jensen M.D., Handwerger B.S., Scheithauer B.W., Carpenter P.C., Mirakian R., Banks P.M. Lymphocytic hypophysitis with isolated corticotropin deficiency. Ann. Intern. Med. 105: 200, 1986.
Eisenbarth G.S. Type I diabetes mellitus. A chronic autoimmune disease. N. Engl. J. Med. 314: 1360, 1986.
Asa S.L., Bilbao J.M., Kovacs K., Josse R.G., Kreines K. Lymphocytic hypophysitis of pregnancy resulting in hypopituitarism. A distinct clinicopathologic entity. Ann. Intern. Med. 95: 160, 1981.
Eisenbarth G.S. The immunoendocrinopathy syndromes. In: Wilson I.D., Foster D.W. (eds.), Williams’ Textbook of Endocrinology. Saunders, Philadelphia, 1985, p. 1290.
Drell D.W., Notkins A.L. Multiple immunological abnormalities in patients with type 1 (insulin-dependent) diabetes mellitus. Diabetologia 30: 132, 1987.
Daughaday W.H. The anterior pituitary. In: Wilson I.D., Foster D.W. (eds.), Williams’ Textbook of Endocrinology. Saunders, Philadelphia, 1985, p. 591.
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Giustina, A., Candrina, R., Cimino, A. et al. Development of isolated ACTH deficiency in a man with type I diabetes mellitus. J Endocrinol Invest 11, 375–377 (1988). https://doi.org/10.1007/BF03349058
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DOI: https://doi.org/10.1007/BF03349058