A case of adult GH deficit in a woman with Autoimmune Polyendocrine Syndrome type II
D Pietrobono, G Bassotti, F Diacono, R Iuorio, V Mercuri & P Gargiulo
We report a case of a 53 years old woman who presented asthenia, cramps, cutaneous hyperpigmentation, nausea, vomiting, vague and non-specific epigastric abdominal pain, weight loss and hypotension. She was diagnosed with Addisons disease because biochemical data were indicative for autoimmune adrenal failure (positivity for adrenal cortex antibodies). Nevertheless during the following 9 years the patient began to note the progressive reduction of pubic and axillary hair, an increase of the thyroid gland and irregularity of her menstrual cycle; hormonal and immunological values and ultrasound scan demonstrated primitive hypothyroidism with Hashimoto thyrohiditis and premature ovarian failure associated to the presence of antibodies against ovarian tissue. The patient also showed the specific symptoms of acute hyperglycaemic state and the positivity of GAD antibodies that allowed the diagnosis of diabetes mellitus type 1. She was therefore diagnosed with Schmidts syndrome (Polyglandular Autoimmune Endocrine Insufficiency-PGAII). Despite of an adequate treatment for Addisons disease, hypothyroidism, premature menopause and diabetes mellitus type 1, the patient continued to show fatigue, asthenia, osteoporosis and became overweight (BMI=27.71 kg/m2). Thus we also studied pituitary function with GH-RH+Arginine test in order to evaluate a possible GH-deficit (GHD) due to an autoimmune inflammations of the pituitary gland, because also this gland could be attacked by organ specific autoantibodies, and in relation to the persistence of clinical symptomatology. The patient was diagnosed with GH deficit in adult (GH nadir during GH-RH+Arginine test: 5 ng/ml). The diagnostic hypothesis is that GHD, in this patient, was caused by autoimmune hypophysitis within Autoimmune Polyendocrine Syndrome type II. Nevertheless antipituitary antibodies (APA) were negative, we suppose that their absence was because they became negative during the time elapsed between hypophysitis onset and its diagnosis.