{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T13:35:27Z","timestamp":1762004127273},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Thyroid Res"],"published-print":{"date-parts":[[2008,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>46 year old patient was admitted as an emergency with vomiting, hypotension and serum cortisol of 0,940 \u03bcg\/dl (26 nmol\/l) indicative of adrenal failure. Despite previous history of panhypopituitarism he was found to be hyperthyroid [free T<jats:sub>4<\/jats:sub> 6.32 ng\/dl (ref. range: 0.93\u20131.7), free T<jats:sub>3<\/jats:sub> 22.21 pg\/ml (ref. range: 1.8\u20134.6)]. He was fit and well till the age of 45. Eight months prior to this hospitalisation he presented with diabetes insipidus and was found to have a large cystic tumour in the area of the pituitary gland. Surgery was only partially successful and histologically the tumour was diagnosed as craniopharyngioma. Endocrine assessment revealed deficiency in ACTH-cortisol, growth hormone, and gonadotropin, as well as low-normal free T<jats:sub>4<\/jats:sub>. On the day of his emergency admission he looked ill and dehydrated, though was fully conscious and cooperative. Heart rate was 120 beats\/min (sinus rhythm), blood pressure 85\/40 mm Hg. There were no obvious features of infection, but there was marked tremor and thyroid bruit. He received treatment with intravenous fluids and hydrocortisone. L-thyroxine was stopped. Administration of large dose of methimazole (60 mg\/day) resulted in gradual decrease in free T<jats:sub>4<\/jats:sub> and free T<jats:sub>3<\/jats:sub> (to 1.76 ng\/ml, and 5.92 pg\/ml, respectively) over a 15-day period. The patient was found to have increased titre of antithyroperoxidase (anti-TPO) and anti-TSH receptor (anti-TSHR) antibodies [2300 IU\/l (ref. range &lt;40) and 3.6 IU\/l (ref. range &lt;1.0), respectively]. He was referred for radioactive iodine treatment. Iodine uptake scan performed prior to radioiodine administration confirmed uniformly increased iodine uptake consistent with Graves' disease.<\/jats:p>\n          <jats:p>\n            <jats:bold>Conclusion<\/jats:bold>\n          <\/jats:p>\n          <jats:p>Our case illustrates coexistence of hypopituitarism and clinically significant autoimmune thyroid disease. The presence of hypopituitarism does not preclude the development of autoimmune thyrotoxicosis.<\/jats:p>","DOI":"10.1186\/1756-6614-1-7","type":"journal-article","created":{"date-parts":[[2008,11,19]],"date-time":"2008-11-19T19:11:46Z","timestamp":1227121906000},"update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["New onset Graves' disease as a cause of an adrenal crisis in an individual with panhypopituitarism: brief report"],"prefix":"10.1186","volume":"1","author":[{"given":"Krzysztof C","family":"Lewandowski","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Marcinkowska","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"El\u017cbieta","family":"Skowro\u0144ska-J\u00f3\u017awiak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacek","family":"Makarewicz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrzej","family":"Lewi\u0144ski","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2008,11,19]]},"reference":[{"key":"7_CR1","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/j.ecl.2006.09.004","volume":"35","author":"R Bouillon","year":"2006","unstructured":"Bouillon R: Acute adrenal insufficiency. 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