Houssay phenomenon: a rare case of diabetes mellitus remission

Zhang, Jtw; Ho, Kwk

doi:10.1002/edn.191

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…Apart from hypoglycaemia, cortisol deficiency can also cause hypotension, weight loss, lethargy, gastrointestinal symptoms and electrolyte abnormalities. 10 Cortisol deficiency is associated with increased antidiuretic hormone secretion, which causes hyponatraemia 5 as seen in our patient. Therefore, the presence of unexplained hyponatraemia should alert the clinician to this possibility.…”

Section: Mri Brainmentioning

confidence: 52%

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Lesson of the month 2: Houssay phenomenon – hypopitutarism leading to remission of diabetes

et al. 2016

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Because of a pituitary insult and the subsequent loss of counter-regulatory hormones, individuals can experience increased sensitivity to insulin, hypoglycaemia or even complete amelioration of diabetes; this is known as the Houssay phenomenon. Severe dehydration following diarrhoea can lead to pituitary infarction causing hypopituitarism. We describe this situation in a patient with insulin-treated type-2 diabetes presenting with recurrent hypoglycaemia and cessation of insulin requirement along with weight loss, hypotension and hyponatraemia. Pituitary imaging revealed a partial empty sella and a synacthen stimulation test revealed an initial positive response but later loss of response, proving recent-onset pituitary dysfunction. Physicians should keep this possibility in mind while treating hypoglycaemia in stable diabetic individuals. Judicious supplementation of deficient hormones is of utmost importance.

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Section: Mri Brainmentioning

confidence: 52%

“…to remission of diabetes status. 5 In addition, deliberate, surgical hypophysectomy has been used for the treatment of diabetic retinopathy. A 1965 report in the British Medical Journal describes its use on 223 people with diabetes; with a successful reduction in incidence of 48% of subsequent retinal haemorrhage.…”

Section: Mri Brainmentioning

confidence: 99%

Lesson of the month 2: Houssay phenomenon – hypopitutarism leading to remission of diabetes

et al. 2016

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“…Few cases have been reported and in particular in a geriatric population. [74][75][76] Patients with central hypoadrenalism treated with recombinant human GH (rGH) may need a higher glucocorticoid dose as compared to patients in whom GHD is not replaced, because of the above mentioned effect of GH on 11beta-HSD1 activity. 77 If a patient with central hypoadrenalism needs synthetic glucocorticoids for immunosuppressive or anti-inflammatory purpose at a dose particularly higher than the equivalent replacement daily HC doses, the replacement therapy should be halted.…”

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confidence: 99%

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

Paragliola¹,

Locantore²,

Corsello³

et al. 2023

CIA

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The current increase of life expectancy is associated with the presence of endocrine diseases in the elderly. The management of hypopituitarism in this group of patients is a challenging task. A correct diagnosis, which represents an essential requisite for an appropriate medical treatment, can be difficult because of the physiological changes occurring in pituitary function with aging, which may lead to challenges in the interpretation of laboratory results. Furthermore, the treatment requires several careful considerations: the need to restore the hormonal physiology with replacement therapies must be balanced with the need to avoid the risks of the over-replacement, especially in the presence of concomitant cardiovascular and metabolic disease. Interactions with other drugs able to modify the absorption and/or the metabolism of hormonal replacement therapies should be considered, in particular for the treatment of hypoadrenalism and hypothyroidism. The most important challenges stem from the lack of specific studies focused on the management of hypopituitarism in older people.

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Hypopituitarism Presenting as Recurrent Episodes of Hypoglycemia: Houssay Phenomenon

Rizwan¹,

Arora²,

Alchalabi³

et al. 2023

Cureus

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Hypopituitarism, a rare disorder, is defined as decreased production and secretion of one or more of the hormones that are normally secreted by the pituitary gland, resulting from the diseases of the pituitary gland itself or the hypothalamus. The clinical manifestations of this disorder are usually nonspecific and can lead to life-threatening complications and mortality. Here, we present a case of a 66-year-old female patient who was brought to the ER by her family with concerns of altered mentation. The altered mentation was found to be secondary to a severe hypoglycemic episode, which was later discovered to be due to underlying panhypopituitarism with secondary adrenal insufficiency. Endocrinology was consulted and recommended assessment of the hypothalamic-pituitary axis. The tests revealed low levels of serum insulin and C-peptide along with decreased levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin, cortisol, free thyroxine (T4), and adrenocorticotropic hormone (ACTH). She was started on intravenous hydrocortisone and levothyroxine, which were later switched to oral hydrocortisone and levothyroxine after the stabilization of her blood glucose levels. She was later advised to follow up with endocrinology upon discharge. While evaluating a patient with hypoglycemia, it is important to keep hypopituitarism causing secondary adrenal insufficiency in mind as a differential diagnosis because it can be life-threatening if not recognized early and treated in a timely manner.

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Houssay phenomenon: a rare case of diabetes mellitus remission

Cited by 3 publications

References 14 publications

Lesson of the month 2: Houssay phenomenon – hypopitutarism leading to remission of diabetes

Lesson of the month 2: Houssay phenomenon – hypopitutarism leading to remission of diabetes

Treating Hypopituitarism in the Over 65s: Review of Clinical Studies

Hypopituitarism Presenting as Recurrent Episodes of Hypoglycemia: Houssay Phenomenon

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