A Possible Case of Hypothalamic Hypofunction Caused by Prolonged Malnutrition due to Intestinal Blind Loop
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概要
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We had an opportunity to treat a patient who had been suffering from prolonged. malnutrition. The patient was a 22-year-old male. He was noted to have hypopituitarism clinically. In order to determine the role of malnutrition in the hypopituitarism, several substances and hormones in serum were measured before and after the surgery of intestinal blind loop.<BR>At the time of admission he was noted to have reduced pigmentation, growth retardation, weight loss and delayed adolescence. X-ray examination of his bones showed osteomalacia. Fecal excretion of <SUP>131</SUP>I-triolein for three days was 26.2% of total triolein, indicating that the absorption of fat was impaired.<BR>Significantly low values were found for a basal metabolic rate, 24-hr-<SUP>131</SUP>I uptake of the thyroid, serum T<SUB>4</SUB>, serum T<SUB>3</SUB>-RU, urinary excretion of 17-OHCS and 17-KS.<BR>The thyroidal radioiodine uptake was increased by consecutive injections of TSH.<BR>Plasma TSH was undetectable without TRH, which induced an increase in the plasma level of TSH. Therefore, hypothalamic hypothyroidism was most likely for a diagnosis.<BR>The impaired response of plasma GH to a hypoglycemia induced by insulin was observed. Also, the impaired response of urinary 17-OHCS to metyrapone was observed, although plasma ACTH was not determined.<BR>After surgery for the intestinal blind loop, he was apparently improved in the signs and the symptoms of malnutrition. He also developed a cracked voice, comedos on the face, pubic and axillary hair, and a beard. In addition, he gained 16kg in weight and 4cm in height for 9 months without any other treatment than the surgery. In the determination after surgery, serum lipids and protein were significantly increased, and then a marked increase in plasma levels of hormones was observed.<BR>Consequently it was considered that malnutrition played an important role in this hypopituitarism maybe through a decrease or cessation of the releasing factors, namely, hypothalamic hypofunction.
著者
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Omae Teruo
Second Department Of Internal Medicine Faculaty Of Medicine Kyushu University
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NAKASHIMA TOSHIRO
Second Department of Internal Medicine, Faculty of Medicine Kyushu University
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INOUE KENJIRO
Second Department of Internal Medicine, Faculty of Medicine Kyushu University
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FUCHIGAMI TADAHIKO
Second Department of Internal Medicine, Faculty of Medicine Kyushu University
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OMAE Teruo
Second Department of Internal Mecicine, Faculty of Medicine, Kyushu University
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OMAE TERUO
Second Department of Internal Medicine, Faculty of Medicine Kyushu University
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