M. GARY NICHOLLS, M.B.Ch.B., M.R.A.C.P.; ERIC A. ESPINER, M.D., F.R.A.C.P.; RICHARD A. DONALD, M.D., PH.D., F.R.A.C.P.
A 62-year-old woman who had features suggestive of hypopituitarism was found to have primary autoimmune hypothyroidism and hypoadrenalism (Schmidt's syndrome). Normal hypothalamic-pituitary function was confirmed by normal growth-hormone and brisk adrenocorticotrophic-hormone responses to insulin-induced hypoglycemia, plasma gonadotrophin levels within the normal postmenopausal range, and elevated thyroid-stimulating hormone levels. Adrenal mineralocorticoid reserve was severely impaired, assessed by markedly reduced aldosterone secretion when plasma renin activity values were strikingly raised. Glucocorticoid secretion was near normal, however, and reserve was less severely affected, Judged by a mild elevation in plasma adrenocorticotrophichormone concentration. Thus, autoimmune adrenal disease may affect mineralocorticoid secretion more than glucocorticoid reserve; and the absence of adrenocorticotrophic-hormone and melanocytestimulating-hormone hypersecretion and consequent pigmentation may increase diagnostic confusion with hypopituitarism.
NICHOLLS MG, ESPINER EA, DONALD RA. Schmidt's Syndrome Presenting As Hypopituitarism. Ann Intern Med. 1974;80:505–509. doi: 10.7326/0003-4819-80-4-505
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Published: Ann Intern Med. 1974;80(4):505-509.
Endocrine and Metabolism, Neurology, Pituitary Disorders.
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