A case of XXXX accompanied by recurrent severe @entity4053 .

@entity1 @entity390 @entity6 @entity1640 @entity391 @entity4053 @entity17685 @entity701 @entity6192 @entity479 @entity792 @entity413 @entity617 @entity774
INTRODUCTION: @entity1640 is relatively rare cause of @entity774 which is often accompanied by severe @entity4053 . @entity701 replacement therapy is essential for this condition, but gastrointestinal symptom such as @entity390 and @entity391 is not well-recognized adverse effect of @entity701 . CASE DESCRIPTION: A 64-year-old- @entity1 was referred to our hospital because of frequent severe @entity4053 . She was diagnosed as type 2 @entity6 when she was 58 years old but had not been treated since she was 60. We ruled out the possibility of exogenous administration of insulin or other anti- @entity6 drugs, @entity792 . After @entity413 injection, she once became conscious, but severe @entity4053 was often observed even after that. In addition, counter-regulatory hormone levels were not increased even at the time of @entity4053 . We conducted several hormone load tests. In @entity6192 ( @entity6192 ) load test, excess and delayed reaction of ACTH was observed. In @entity17685 (TRH) load test, TSH and prolactin were normally secreted in response to TRH. In luteinizing hormone-releasing hormone (LHRH) load test, delayed reaction of LH and FSH was observed. Based on such hormone loading tests, we diagnosed this @entity1 as @entity1640 and consequent @entity774 . We immediately intravenously injected @entity701 and started oral @entity701 therapy. However, just after taking @entity701 , @entity391 was often observed which disturbed sufficient @entity479 hormone replacement, leading to recurrent @entity4053 . Therefore, we stopped @entity701 and instead started an alternative treatment with @entity617 . After that, @entity391 and @entity4053 were not observed at all. DISCUSSION AND EVALUATION: We diagnosed this subject as @entity1640 mainly by the following two findings: (1) excess and delayed reaction of ACTH in @entity6192 load test, (2) delayed reaction of LH and FSH in LHRH load test. CONCLUSIONS: We should be aware of the possibility of @entity1640 as a cause of recurrent severe @entity4053 . Also, we should be aware that @entity701 could induce gastrointestinal symptom and that in such a case we should stop @entity701 and start @entity617 to sufficiently replace @entity479 hormone and avoid recurrent @entity4053 .
