An Unusual Cause of Severe Hypoglycaemia in Type 1 Diabetes Mellitus. Antepartum Pituitary Failure: A Case Report and Literature Review

Tahrani, Abd A; West, Tim; Macleod, Andrew

doi:10.1055/s-2007-967092

Cited by 8 publications

(4 citation statements)

References 8 publications

(22 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[5] Our patient had no history of head injury, radiotherapy, or surgical intervention, and MRI showed no evidence of tumors. This patient did not experience acute headaches followed by a sudden reduction in insulin requirements, which would reflect pituitary necrosis [3] ; thus, pituitary necrosis is unlikely to be the etiologic factor in our patient. We also speculated that Sheehan syndrome due to postpartum pituitary infarction following adenohypophyseal vasospasm during postpartum hemorrhaging was unlikely because our patient had no history of postpartum hemorrhage.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Severe hypoglycemia and hyponatremia caused by hypopituitarism in a female patient with type 1 diabetes

Zheng

Qiu²,

H³

2019

Medicine

View full text Add to dashboard Cite

Rationale: The misdiagnosis of hypopituitarism is common due to its rarity and its nonspecific clinical manifestations. Our case report highlights the importance of critical evaluation regarding hypopituitarism as a cause of recurrent hypoglycemia, hyponatremia, and gastrointestinal symptoms in patients with T1DM, as misdiagnosis might be fatal to the patient. Patient concerns: We herein report the case of 35-year-old female patient who presented with 18 years of history of well-controlled type 1 diabetes mellitus and a 6-month history of recurrent nausea and vomiting, generalized weakness, hyponatremia, and severe hypoglycemia, despite a reduction in the dose of insulin. She was considered as having “type 1 diabetes and gastroparesis.” Four months later, she was diagnosed with hypothyroidism, and 25 μg/d of levothyroxine was prescribed. However, the levothyroxine had to be discontinued 1 week later because of frequent vomiting by the patient. Diagnosis: Further evaluation in our hospital revealed low-normal adrenocorticotropic hormone, low-normal serum cortisol, and low 24-hours urinary cortisol excretion. Secondary hypothyroidism and hypogonadotropic hypogonadism were also demonstrated. Based on the endocrinological findings, she was diagnosed with hypopituitarism possibly due to lymphocytic hypophysitis. Diabetic nephropathy was another diagnosis made after kidney biopsy. Interventions: The patient was treated with 100 mg/d of hydrocortisone intravenously for 2 weeks. After that, she continued on 15 mg/d of prednisone, and then 25 μg/d of levothyroxine was administered. Outcomes: The patient's insulin requirement increased to a premorbid level, the severe hypoglycemia resolved, the physical discomforts were alleviated, and blood electrolytes returned to normal. Lessons: This uncommon case reinforced the significance of a timely diagnosis and appropriate treatment of hypopituitarism. We recommend that physicians focus their awareness on this potentially life-threatening disease, as it is a condition potentially fatal to the patient if not recognized and treated.

show abstract

Section: Discussionmentioning

confidence: 98%

“…Hypopituitarism could lead to recurrent hypoglycemia in diabetic patients and to a reduction in their insulin requirements as a result of adrenocorticotropic hormone deficiency (the Houssay phenomenon). [3,4] Obscure recurrent hypoglycemia requires endocrinologic tests to clarify possible underlying hypocortisolism. [5]…”

Section: Discussionmentioning

confidence: 99%

Severe hypoglycemia and hyponatremia caused by hypopituitarism in a female patient with type 1 diabetes

Zheng

Qiu²,

H³

2019

Medicine

View full text Add to dashboard Cite

show abstract

“…‘Frequent severe hypoglycaemia’ occurred in a patient with concomitant Type 1 diabetes and pituitary GH deficiency. GH replacement therapy abolished these events, suggesting that pituitary GH deficiency played a role in the risk of ‘frequent severe hypoglycemia’[25]. IGF‐I replacement therapy in non‐pregnant patients with Type 1 diabetes improved glycaemic control without increasing the frequency of hypoglycaemia [26].…”

Section: Discussionmentioning

confidence: 99%

Lower levels of circulating IGF‐I in Type 1 diabetic women with frequent severe hypoglycaemia during pregnancy

et al. 2008

View full text Add to dashboard Cite

In women with Type 1 diabetes experiencing frequent severe hypoglycaemia during pregnancy, IGF-I levels are significantly lower compared with the remaining women despite similar placental GH levels. IGF-I levels are lowest in early pregnancy where the incidence of severe hypoglycaemia is highest. IGF-I may be a novel factor of interest in the investigation of severe hypoglycaemia in patients with Type 1 diabetes.

show abstract

“…The specific mechanism of pituitary necrosis is unclear, and it is generally accepted that hypotension incurs pituitary ischemia leading to necrosis (2). However, antepartum pituitary necrosis which is unrelated to massive intra or postpartum hemorrhage, is a very rare condition in pregnancy and has only been reported in patients with long standing type I diabetes mellitus (DM) (3). In this case report we present for the first time antepartum pituitary necrosis that complicated a pregnant patient with uncontrolled gestational diabetes mellitus (GDM).…”

Section: Introductionmentioning

confidence: 99%

Antepartum Pituitary Necrosis Occurring In Pregnancy with Uncontrolled Gestational Diabetes Mellitus: A Case Report

et al. 2010

View full text Add to dashboard Cite

Antepartum pituitary necrosis is a rare medical condition that has only been reported in pregnant women with type I diabetes attributable to diabetes-related vasculopathy and hypercoagulability. We present for the first time a case of antepartum pituitary necrosis occurring in an uncontrolled gestational diabetes mellitus (GDM) patient. The patient was a 32-yr-old woman at 33 weeks and 2 days of gestation. She suffered from severe headache, blurred vision, dizziness, and vomiting. Her baby was delivered by Cesarean section. The brain magnetic resonance images revealed pituitary necrosis. This suggests that pituitary gland necrosis may also complicate GDM pregnancy when glucose levels are uncontrolled.

show abstract

An Unusual Cause of Severe Hypoglycaemia in Type 1 Diabetes Mellitus. Antepartum Pituitary Failure: A Case Report and Literature Review

Cited by 8 publications

References 8 publications

Severe hypoglycemia and hyponatremia caused by hypopituitarism in a female patient with type 1 diabetes

Severe hypoglycemia and hyponatremia caused by hypopituitarism in a female patient with type 1 diabetes

Lower levels of circulating IGF‐I in Type 1 diabetic women with frequent severe hypoglycaemia during pregnancy

Antepartum Pituitary Necrosis Occurring In Pregnancy with Uncontrolled Gestational Diabetes Mellitus: A Case Report

Contact Info

Product

Resources

About