title: Hypopituitarism Presenting as Adrenal Insufficiency and Hypothyroidism in a Patient with Wilson's Disease: a Case Report.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Daedong Hospital, Busan, Korea .
authors.forename: Hae Won
authors.identifier: 0000-0002-7744-2187
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Daedong Hospital, Busan, Korea .
authors.forename: Jin Du
authors.identifier: 0000-0003-2191-7718
authors.initials: JD
authors.lastname: Kang
authors.affiliation: Department of Internal Medicine, Daedong Hospital, Busan, Korea .
authors.forename: Chang Woo
authors.identifier: 0000-0001-5753-4191
authors.initials: CW
authors.lastname: Yeo
authors.affiliation: Department of Internal Medicine, Daedong Hospital, Busan, Korea .
authors.forename: Sung Woon
authors.identifier: 0000-0001-7073-020X
authors.initials: SW
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, Daedong Hospital, Busan, Korea .
authors.forename: Kwang Jae
authors.identifier: 0000-0001-5468-6499
authors.initials: KJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, New Tong Yeong Hospital, Tongyeong, Korea .
authors.forename: Mun Ki
authors.identifier: 0000-0002-5725-7128
authors.initials: MK
authors.lastname: Choi
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis / Q000209:etiology; D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging; D003863:Depression / Q000209:etiology; D005260:Female; D006527:Hepatolenticular Degeneration / Q000150:complications*; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D007037:Hypothyroidism / Q000175:diagnosis / Q000209:etiology; D008103:Liver Cirrhosis / Q000150:complications / Q000000981:diagnostic imaging; D008279:Magnetic Resonance Imaging; D013256:Steroids / Q000627:therapeutic use; D013973:Thyrotropin-Releasing Hormone / Q000627:therapeutic use
chemical_list: D013256:Steroids; D013973:Thyrotropin-Releasing Hormone
keywords: Adrenal Insufficiency; Hepatolenticular Degeneration; Hypopituitarism; Hypothyroidism