Tragl K H, Haydl H, Kleinberger G, Kotzaurek R, Lugscheider R, Kretschmer G, Wolff E
Wien Klin Wochenschr. 1975 Feb 7;87(3):92-6.
The diversity of clinical manifestations of Boeck's sarcoidosis may also include endocrine disorders. One year after diagnosis of sarcoidosis in a 29 year-old female patient, endocrinological complications became manifest with amenorrhoea. The course of the disease was additionally complicated by hypoglycaemic episodes. Thorough clinical investigation of the patient revealed sarcoid involvement of the skin, lungs, liver and lymph nodes and an extensive retroperitoneal surgically-verified lymph tumour. After tolbutamide and in reaction to an intravenous glucose tolerance test the blood glucose was found to be very low, whilst the immunoreactive insulin was normal. Further investigation of the endocrine functions of the patient revealed normal functioning of the thyroid gland, subnormal values for the follicle stimulating hormone and extremely low serum ACTH and serum cortisol values, without any diurnal changes in these parameters. The clinical symptoms of the patient and the biochemical findings were regarded as manifestations of secondary adrenal failure due to sarcoid involvement of the hypothalamus and pituitary. Hence, treatment with corticosteroids was started. Hypoglycaemia has not since been observed in this patient and the other clinical features of (secondary) adrenal failure have disappeared slowly.
结节病的临床表现多样性还可能包括内分泌紊乱。一名29岁女性患者被诊断为结节病一年后，出现闭经等内分泌并发症。疾病进程还因低血糖发作而复杂化。对该患者进行全面临床检查发现，皮肤、肺、肝和淋巴结有结节病累及，且有一个经手术证实的广泛腹膜后淋巴瘤。服用甲苯磺丁脲后，经静脉葡萄糖耐量试验发现血糖非常低，而免疫反应性胰岛素正常。对该患者内分泌功能的进一步检查显示甲状腺功能正常，促卵泡激素值低于正常，血清促肾上腺皮质激素和血清皮质醇值极低，且这些参数无昼夜变化。患者的临床症状和生化检查结果被认为是结节病累及下丘脑和垂体导致继发性肾上腺功能衰竭的表现。因此，开始使用皮质类固醇进行治疗。此后该患者未再出现低血糖，（继发性）肾上腺功能衰竭的其他临床特征也逐渐消失。
