Failed titration of endocrine replacement therapy: diagnostic significance.

Unsuccessful titration of endocrine replacement therapy may signify the coexistence of an unrecognized disorder which alters the response to replacement therapy. Examples include recurrent hypoglycaemia when type 1 diabetes mellitus coexists with either Addison's disease or coeliac disease. Recurrent Addisonian crisis occurs when Addison's disease coexists with thyrotoxicosis. Conversely, in a patient with Addison's disease, recognition and treatment of coexisting coeliac disease may facilitate a reduction in corticosteroid dosage.