Flexion contractures syndrome as the initial manifestation of hypopiptuitarism
Hadj Ali Insaf, Khiari Karima, Mchirgui Nadia, Lakhoua Youssef & Ben Abdallah Nejib
We present a 58 years old woman admitted in our department for bradycardia, diarrhea, epigastralgia, anorexia and weight loss. Physical examination showed low blood pressure and inability to walk or stand due to severe flexion contractures of the lower extremities without neurological abnormalities. The biological findings showed severe hyponatremia, hyerkaliemia tendency, low levels of plasma cortisol and ACTH suggesting pituitary adrenal axis deficiency. Hormonal investigations conclude at the association of thyroid and gonadal deficiency. Medical history suggest Sheehan syndrome as etiology of hypopituitarism. The patient was submitted to glucocorticoid replacement therapy and we observed a remarkable relief from all the above symptoms. Hence, in patients with flexion contractures syndrome, the pituitary axis and specially pituitary adrenal axis should be evaluated.