PITUITARY INSUFFICIENCY ASSOCIATED WITH DIABETES MELLITUS

Abstract

PITUITARY insufficiency in a patient with diabetes mellitus is sufficiently uncommon to warrant the report of a case including clinical and biochemical investigations, with special reference to the adrenal cortex, thyroid gland and the disordered metabolism of diabetes mellitus. Simmonds in 1914 (1) described a condition of severe cachexia which might result from a lesion of the anterior hypophysis. Sheehan in 1939 (2) showed that milder cases occur, in which some of the classic symptoms are absent. It would seem, therefore, that not all the anterior pituitary hormones are equally affected, and consequently there are varied clinical and biochemical presentations, such as “pituitaiy myxedema,” “pituitary adrenal failure,” and “pituitaiy hypogonadism.“ Sheehan and Summers in 1949 (3) stated that the degree of destruction of the gland can be correlated with the severity of the clinical state. Reduction of pituitary function also affects carbohydrate metabolism, as manifested by increased insulin sensitivity and fasting hypoglycemia. In 1942 Houssay and his associates (4) showed the ameliorating effect of hypophysectomy on experimental diabetes. In man, the equivalent of this phenomenon is rare; Only 11 cases have been reported, in which diabetes mellitus has been mitigated by the subsequent development of pituitary insufficiency (5–15). In several of these cases necrosis of the pituitary gland was found at autopsy. One patient died in hypoglycemic coma. In 4 patients the condition developed following a pregnancy.