Hypopituitarism Presenting as Recurrent Episodes of Hypoglycemia: Houssay Phenomenon
Open accessAbstract
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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Genuine endocrine diseases, like pituitary or adrenal insufficiency, should also be considered especially if patients present with other symptoms suggestive of these diseases.
“Genuine endocrine diseases, like pituitary or adrenal insufficiency, should also be considered especially if patients present with other symptoms suggestive of these diseases [11,12].”
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Cites
Cryer, P. E., Axelrod, L., Grossman, A. B., Heller, S. R., Montori, V. M., Seaquist, E. R., & Service, F. J. (2009) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2008-1410 · Cited by 1,277 · cited 1× · see citing works
“After these have been excluded, attention should be brought to other potential causes, including hepatic/renal failure, sepsis, excessive alcohol intake, nonislet cell tumors, insulinoma, insulin autoimmune hypoglycemia, and hypopituitarism leading to loss of counter-regulatory mechanisms [6].”
BackgroundPrevalence and incidence of hypopituitarism in an adult Caucasian population in northwestern Spain
Regal, M., Páramo, C., Sierra, J. M., & García‐Mayor, R. V. (2001) · Clinical Endocrinology · doi:10.1046/j.1365-2265.2001.01406.x · Cited by 354 · see citing works
Schneider, H. J., Aimaretti, G., Kreitschmann-Andermahr, I., Stalla, G.-K., & Ghigo, E. (2007) · The Lancet · doi:10.1016/s0140-6736(07)60673-4 · Cited by 336 · see citing works
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Research works printed but not linked: 5
- [3]Etiology of hypopituitarism in tertiary care institutions in Turkish population: analysis of 773 patients from Pituitary Study Group database Endocrine Tanriverdi F Dokmetas HS Kebapcı N 198 205 47 2014 24366641
- [5]Hypoglycemia and diabetes: a report of a workgroup of the American Diabetes Association and the Endocrine Society J Clin Endocrinol Metab Seaquist ER Anderson J Childs B 1845 1859 98 2013 23589524
- [7]A case of hypothalamic hypopituitarism accompanied by recurrent severe hypoglycemia Springerplus Takai M Kaneto H Kamei S Mune T Kaku K 173 4 2015 25918682 PMC4402679
- [9]Recurrent hypoglycemia in diabetic patient with hypopituitarism: the Houssay phenomenon Cureus Gaffar Mohammed M Baloch J Alsahhar AM Alhabashi BM 0 13 2021 PMC7894213 33628705
- [10]The Houssay phenomenon, another clue to Sheehan's syndrome in a diabetic Diabet Med Hadithi M Toorians A Heine R 795 19 2002 12207822
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Dieterle, M. P., Husari, A., Prozmann, S. N., Wiethoff, H., Stenzinger, A., Röhrich, M., Pfeiffer, U., Kießling, W. R., Engel, H., Sourij, H., et al. (2023) · Biomedicines · doi:10.3390/biomedicines11061741 · Cited by 5 · see citing works
“Genuine endocrine diseases, like pituitary or adrenal insufficiency, should also be considered especially if patients present with other symptoms suggestive of these diseases [11,12].”
Background
- Authors
- Rizwan, T., Arora, G., Alchalabi, M., & Qureshi, F.
- Affiliations
- Ascension (US)
- Corresponding author
- Rizwan, Tehlil
- ORCID
- Rizwan, Tehlil
- Venue
- Cureus
- Published
- 2023-04-13
- Volume
- 15
- Issue
- 4
- Pages
- e37530-e37530
- ISSN
- 2168-8184 (ISSN-L)
- PMC
- PMC10182777
- OpenAlex
- W4376491152
- Cited by
- 3
- References
- 3
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 1
- FWCI
- 0.62
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Cureus (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Keywords
- hypopituitarism, panhypopituitarism, recurrent hypoglycemia, secondary adrenal insufficiency, hypothalamic-pituitary axis, altered mental status, cortisol, levothyroxine, differential diagnosis of hypoglycemia, C-peptide, ACTH
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