DIABETES MELLITUS FOLLOWED BY ADDISON'S DISEASE AND HYPOTHYROIDISM, SIMULATING PANHYPOPITUITARISM

Abstract

IN 1938 Bloomfield (1) reported a unique, unequivocal case of coincidental diabetes mellitus and Addison's disease. The same case again appeared in the literature in 1944, when Armstrong (2) reported the effect of testosterone on this patient's condition. Since the last report, the clinical picture of hypothyroidism in this patient became more striking, and finally a diagnosis of panhypopituitarism was made. The present paper will summarize briefly the clinical course and interval history since last reported, and present the autopsy findings. CASE HISTORY A 35-year-old American electrician first entered Stanford University Hospital, April 18, 1938, complaining of weakness and weight loss of 18 pounds in two months. One sister died of diabetes mellitus at the age of 18 years, and a niece at the age of 3 years. The rest of the family history was not pertinent. In March of 1938, there was a sudden appearance of increased thirst and polyuria. At this time physical examination of the patient was not remarkable; his weight was 49 kilograms and his blood pressure was 120/75. There was sugar, diacetic acid and acetone in the urine, and the blood sugar was 560 mg. per cent. Diet and 56 units of insulin per day restored his blood sugar to a normal level. After an interval of well-being with fair control of his diabetes, he experienced an insulin reaction in December 1938. Because of subsequent reactions his insulin was eventually reduced from 40 to 4 units once or twice daily.