Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.

Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report

Wilson's disease typically presents symptoms associated with liver damage or neuropsychiatric disturbances, while endocrinologic abnormalities are rare. We report an unprecedented case of hypopituitarism in a patient with Wilson's disease. A 40-year-old woman presented with depression, general weakness and anorexia. Laboratory tests and imaging studies were compatible with liver cirrhosis due to Wilson's disease. Basal hormone levels and pituitary function tests indicated secondary hypothyroidism and adrenal insufficiency due to hypopituitarism. Brain MRI showed T2 hyperintense signals in both basal ganglia and midbrain but the pituitary imaging was normal. She is currently receiving chelation therapy along with thyroid hormone and steroid replacement. There may be a relationship between Wilson's disease and hypopituitarism. Copper deposition or secondary neuronal damage in the pituitary may be a possible explanation for this theory.

Successful Treatment of BK Virus-Associated Hemorrhagic Cystitis in a Kidney Transplant Patient: a Case Report / 대한내과학회지

Hemorrhagic cystitis is defined as diffuse mucosal inflammation of the urinary bladder that presents with gross hematuria. A variety of factors, including chemotherapeutic agents, radiation therapy and infection, can cause hemorrhagic cystitis. Among them, BK virus-associated hemorrhagic cystitis is common in patients who have undergone stem cell transplantation but relatively rare in kidney transplantation patients. Here, we present the case of a kidney-transplant patient with BK virus-associated hemorrhagic cystitis and interstitial nephritis who was successfully treated with leflunomide and ciprofloxacin.

Myxedema Coma Successfully Treated by Low Dose Oral Levothyroxine

Myxedema coma is a severe life-threatening form of hypothyroidism that is associated with a high mortality rate. It is known to be common in the elderly, and is mainly accompanied with cardiogenic shock, respiratory failure, central nervous system dysfunction, and body temperature regulation defects. Thus, immediate management is required in order to prevent fatal complications in myxedema coma. However, early detection is difficult and further, it is easily misdiagnosed due to its low incidence rate and nonspecific symptoms. We report a case of myxedema coma which was misdiagnosed for heart failure. The patient was successfully treated with intensive care and oral low dose levothyroxine.

A Case of Renal Tubular Acidosis Associated With Graves' Disease

Renal tubular acidosis (RTA) is a metabolic acidosis caused by impaired excretion of hydrogen ions or reabsorption of bicarbonate. Disorders caused by impairment of bicarbonate reabsorption in the proximal tubule are classified as proximal RTA, whereas those resulting from impairment of hydrogen ion secretion at the distal tubule are called distal RTA. The most common causes of distal renal tubular acidosis in adults are autoimmune disorders including Sjogren syndrome, systemic lupus erythematosis, rheumatoid arthritis, and autoimmune thyroiditis. Of the thyroiditis states, Graves' disease-associated RTA is a rare disease. We experienced and managed one case of hypokalemic muscle weakness associated with Graves' disease and distal renal tubular acidosis.