Type 1 Diabetes Mellitus and Isolated Adrenocorticotropin Deficiency Manifested by Parkinsonism: A Case Report and Literature Review

Nobumasa Ohara; Naoyuki Kojima; Takashi Sato; Tomoo Ikarashi; Hirohito Sone; Yutaka Oki; Kyuzi Kamoi; Masao Hara; Hideo Sasaki

doi:10.2169/internalmedicine.54.5022

CASE REPORTS

Type 1 Diabetes Mellitus and Isolated Adrenocorticotropin Deficiency Manifested by Parkinsonism: A Case Report and Literature Review

Nobumasa Ohara, Naoyuki Kojima, Takashi Sato, Tomoo Ikarashi, Hirohito Sone, Yutaka Oki, Kyuzi Kamoi, Masao Hara, Hideo Sasaki

Author information

Nobumasa Ohara
Department of Endocrinology and Metabolism, Niigata Medical Center, Japan
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Japan
Naoyuki Kojima
Department of Neurology, Niigata Medical Center, Japan
Takashi Sato
Department of Orthopedic Surgery, Niigata Medical Center, Japan
Tomoo Ikarashi
Department of Endocrinology and Metabolism, Niigata Medical Center, Japan
Hirohito Sone
Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Japan
Yutaka Oki
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan
Kyuzi Kamoi
Center of Diabetes, Endocrinology and Metabolism, Joetsu General Hospital, Japan
Masao Hara
Department of Endocrinology and Metabolism, Niigata Medical Center, Japan
Hideo Sasaki
Department of Endocrinology and Metabolism, Niigata Medical Center, Japan

Keywords: isolated adrenocorticotropin deficiency, type 1 diabetes mellitus, Hashimoto thyroiditis, polyglandular autoimmune syndrome, parkinsonism, orthopedic surgery

JOURNAL OPEN ACCESS

2015 Volume 54 Issue 20 Pages 2629-2635

DOI https://doi.org/10.2169/internalmedicine.54.5022

Details

Abstract

A 67-year-old woman developed isolated adrenocorticotropin deficiency (IAD), which manifested as lethargy, a 20-kg body weight loss, hypoglycemia, and parkinsonism, and began corticosteroid replacement. Her symptoms resolved rapidly, and her weight returned to normal within six months. However, she then developed slowly progressive type 1 diabetes mellitus (T1D) with co-existing Hashimoto thyroiditis, and commenced insulin therapy. To our knowledge, this is the first reported case of parkinsonism associated with IAD. In addition, because diabetes mellitus, including T1D, could be latent in patients with untreated IAD, careful assessment of glucose metabolism is needed after commencing corticosteroid replacement until weight regain is achieved.

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