title: Lesson of the month 2: Houssay phenomenon - hypopitutarism leading to remission of diabetes.
abstract: Because of a pituitary insult and the subsequent loss of counter-regulatory hormones, individuals can experience increased sensitivity to insulin, hypoglycaemia or even complete amelioration of diabetes; this is known as the Houssay phenomenon. Severe dehydration following diarrhoea can lead to pituitary infarction causing hypopituitarism. We describe this situation in a patient with insulin-treated type-2 diabetes presenting with recurrent hypoglycaemia and cessation of insulin requirement along with weight loss, hypotension and hyponatraemia. Pituitary imaging revealed a partial empty sella and a synacthen stimulation test revealed an initial positive response but later loss of response, proving recent-onset pituitary dysfunction. Physicians should keep this possibility in mind while treating hypoglycaemia in stable diabetic individuals. Judicious supplementation of deficient hormones is of utmost importance.
authors.affiliation: Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
authors.forename: Subhodip
authors.initials: S
authors.lastname: Pramanik
authors.affiliation: Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
authors.forename: Rana
authors.initials: R
authors.lastname: Bhattacharjee
authors.affiliation: Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
authors.forename: Pradip
authors.initials: P
authors.lastname: Mukhopadhyay
authors.affiliation: Department of Endocrinology, Institute of Post-Graduate Medical Education and Research, Kolkata, India.
authors.forename: Sujoy
authors.initials: S
authors.lastname: Ghosh
mesh_terms: D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology; D003967:Diarrhea; D006801:Humans; D007003:Hypoglycemia; D007010:Hyponatremia; D007018:Hypopituitarism / Q000150:complications / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D012075:Remission, Spontaneous
keywords: Houssay; Hypoglycaemia; cortisol deficiency; diarrhoea; hyponatremia