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首页> 外文期刊>DMW: Deutsche Medizinische Wochenschrift >Rare cause of recurrent hypoglycaemia in type 1 diabetes mellitus - Case 6/2013 [Seltene Ursache rezidivierender Hypoglyk?mien bei Diabetes mellitus Typ 1 - Fall 6/2013]
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Rare cause of recurrent hypoglycaemia in type 1 diabetes mellitus - Case 6/2013 [Seltene Ursache rezidivierender Hypoglyk?mien bei Diabetes mellitus Typ 1 - Fall 6/2013]

机译：1型糖尿病复发性低血糖的罕见病因-病例6/2013 [1型糖尿病复发的低血糖的罕见病因-病例6/2013]

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History and admission findings: We report on a 44-year-old patient with type 1 diabetes who suffered from vomiting and diarrhoea for 10 days as well as episodes of recurrent hypoglycaemia with reduced insulin requirements. Medical history was remarkable for nasopharyngeal carcinoma that had been treated by radiation and chemotherapy five years earlier. Investigations: Laboratory results showed hyponatraemia, reduced free thyroxine with normal thyroid- stimulating hormone and diminished morning serum cortisol levels. Short synacthen test revealed inadequate stimulation of cortisol. Corticotropin- releasing hormone test showed a subnormal stimulation of cortisol with a strong increase of adrenocorticotropin. Besides, testosterone, luteinizing hormone and insulin- like growth factor-1 levels were reduced. The growth hormone-releasing hormone-arginine test revealed complete growth hormone deficiency. A MRI of the sella revealed no abnormalities in hypothalamus and pituitary gland. Diagnosis, treatment and course: Findings were consistent with panhypopituitarism following radiotherapy for nasopharyngeal carcinoma. A replacement therapy was started comprising hydrocortisone, L-thyroxine and testosterone. Accordingly, symptomatology improved. Conclusions: Obscure recurrent hypoglycaemia requires endocrinological tests to clarify possible underlying hypocortisolism.
机译：病史和入院发现：我们报道了一名44岁的1型糖尿病患者，该患者患有呕吐和腹泻10天，以及反复出现的低血糖发作和胰岛素需求减少。五年前经放射和化学疗法治疗的鼻咽癌的病史十分显着。研究：实验室结果显示低血钠，正常甲状腺刺激激素使游离甲状腺素减少，早晨血清皮质醇水平降低。简短的synynhen试验表明皮质醇刺激不足。促肾上腺皮质激素释放激素试验显示，肾上腺皮质激素的强烈增加导致皮质醇的刺激低于正常水平。此外，睾丸激素，促黄体生成激素和胰岛素样生长因子-1水平降低。生长激素释放激素精氨酸测试显示完全生长激素缺乏。蝶鞍的MRI显示下丘脑和垂体无异常。诊断，治疗和过程：发现与鼻咽癌放疗后的全垂体功能减退一致。开始替代治疗，包括氢化可的松，左旋甲状腺素和睾丸激素。因此，症状改善。结论：模糊的复发性低血糖症需要进行内分泌学检查，以阐明可能的潜在皮质醇缺乏症。

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