Abstract
This report describes a case of pituitary dwarfism in a 24-year-old woman of 138.8 cm in height. The patient was born by breech presentation and was in a state of apparent death for a few hours immediately after delivery. Skull x-ray and skull CT scanning did not reveal any organic lesions in the brain and the visual field was normal. Osseous matu-ration was delayed and the bone age determined by X-ray films of the epiphysial center of the hand and wrist was calculated to be 14 years. In hormonal examinations, GH secre-tion was not stimulated by the administration of insulin, l-DOPA or glucagon-propranolol. No response of LH and FSH by LH-RH, delayed response of TSH and normal response of PRL by TRH infusion were shown, respectively. The patient did not complain of polyuria and polydipsia, and the basal ADH level in plasma was 1.75 pg/ml. Low levels of serum cortisol and plasma ACTH in the samples obtained in the morning such as 1.7-2.6 μg/dl and below 7.5-13.1 pg/ml, respectively, were shown, and both hormones were insufficently stimulated by insulin infusion. Twenty-four hour urinary 17-OHCS and 17-KS (0.5-4.2 mg and 0.9-2.5 mg per day, respectively) were also decreased, and the response of the urinary steroid metabolites were poor by metyrapone and were delayed by ACTH administration. The results for the pituitary-adrenal function indicated that the patient had suffered from partial secondary adrenal insufficiency in addition to complete GH deficiency. In spite of such a pathological state, clinical signs and symptoms of adrenal insufficiency during and after metyrapone and insulin administration were never manifested. One day about one month after the therapy by hGH was started, the patient suddenly developed high fever, nausea and general malaise, and lowering of blood pressure and mild lowering of serum sodium concentration were detected. These states, which subsided soon after the intra-venous infusion of cortisol, were considered to be inconsistent with those of acute adrenal insufficiency. Thus, it was speculated that the masked adrenal insufficiency in this case might have been manifested by the treatment with hGH.
