Gaffar Mohammed Mohammed, Baloch Javeria, Alsahhar Ahmed M, Alhabashi Budur M
Internal Medicine, Dr. Sulaiman Al Habib Hospital, Riyadh, SAU.
Internal Medicine, College of Medicine, Alfaisal University, Riyadh, SAU.
Cureus. 2021 Feb 18;13(2):e13422. doi: 10.7759/cureus.13422.
The association of treatment of diabetes mellitus and hypoglycemia is well described in the literature. However, the association of recurrent hypoglycemia in diabetic patients with hypopituitarism has been rarely described. This phenomenon, called Houssay phenomenon, usually occurs in individuals with a long diabetes evolution. It is caused by the failure of counter-regulatory hormones produced by the anterior pituitary gland to correct hypoglycemia. We describe this phenomenon in an elderly female known with type 2 diabetes mellitus taking insulin and oral diabetes medications. Workup showed partially empty sella on pituitary imaging. Hormonal assessment showed very low morning cortisol, low adrenocorticotropin hormone (ACTH) and zero response to synacthen. Loss of these counter-regulatory hormones leads to hypoglycemia (Houssay phenomenon). Hypopituitarism has several causes, including pituitary adenoma and traumatic brain injury as common causes among the others. In our reported case, we correlate our patient's condition to Houssay phenomenon, for the implication of refractory hypoglycemic episodes and cortisol deficiency, all of which are the consequences of hypopituitarism. Clinicians should be aware of the link between diabetes and hypopituitarism to avoid deleterious consequences of hypoglycemia.
糖尿病治疗与低血糖之间的关联在文献中有充分描述。然而，糖尿病患者反复低血糖与垂体功能减退之间的关联却鲜有报道。这种现象，即豪赛现象，通常发生在糖尿病病程较长的个体中。它是由垂体前叶产生的反调节激素无法纠正低血糖所致。我们在一位已知患有2型糖尿病且正在使用胰岛素和口服降糖药的老年女性患者中描述了这种现象。垂体成像显示垂体窝部分空泡蝶鞍。激素评估显示清晨皮质醇水平极低，促肾上腺皮质激素（ACTH）水平低，对合成促肾上腺皮质激素无反应。这些反调节激素的缺失导致低血糖（豪赛现象）。垂体功能减退有多种原因，包括垂体腺瘤和创伤性脑损伤等常见原因。在我们报道的病例中，我们将患者的病情与豪赛现象相关联，因为存在难治性低血糖发作和皮质醇缺乏，而这一切都是垂体功能减退的后果。临床医生应意识到糖尿病与垂体功能减退之间的联系，以避免低血糖带来的有害后果。
