Addison's disease and corticosteroid-reversible hypothyroidism

We report the case of a 28-year-old man who presented with idiopathic adrenal insufficiency and subclinical hypothyroidism documented by elevated basal thyrotropin level with abnormal response to thyrotropin-releasing hormone administration. Anti-thyroid antibodies were present in high titer, supporting the diagnosis of Hashimoto's thyroiditis, and hence of autoimmune polyglandular syndrome type II. The patient was not submitted to thyroxine therapy, and during cortisol replacement thyroid function improved, as judged by normalization of basal and stimulated thyrotropin and elevation of thyroid hormone levels. Anti-thyroid antibodies titer significantly diminished, and a short-time withdrawal of corticosteroids was not followed by elevation of thyrotropin hormone levels. Possible pathogenetic mechanisms of cortisone-induced remission of hypothyroidism due to chronic lymphocytic thyroiditis are discussed.     

Subclinical hypothyroidism in Addison's disease.

Fourteen patients with Idiopathic Addison's disease (IAD) were studied in order to detect a possible subclinical hypothyroid state. All were clinically euthyroid with normal serum thyroxine (T4) and serum 3,5',5'-triiodothyronine (T3). Eleven had circulating thyroid microsomal antibodies in blood. The mean basal serum TSH was significantly higher than that of the control group but only three patients had values above the upper normal range. The mean value of serum T4 was decreased as compared to that of the normal persons, while serum 3,3',5'-triiodothyronine was elevated. 7.5 mU bovine thyrotrophin per kilogram body weight injected intravenously caused a rise in serum T3 not different from the response in normals. However, as well increasing serum TSH as increasing microsomal antibody titer correlated significantly to decreasing thyroidal release of T3. Our results suggest that clinically euthyroid patients suffering from IAD might have a beginning thyroidal insufficiency because of a progressive immunological damage of the thyroid.     

Chronic thyroiditis with hypothyroidism in patients with Addison's disease

The authors describe two cases of Schmidt's syndrome (combined idiopathic Addison's disease and chronic autoimmune thyroiditis). In both cases, the damage to the thyroid gland occurred before adrenal pathology. In one case it was associated with overt hypothyrosis and in the other one with subclinical hypothyrosis. It is suggested that these diseases are caused by an autoimmune process, which is supported by demonstration in the blood of both patients of antibodies against thyroid and adrenal tissues.     

Diabetes mellitus and oral disease

The oral complications of diabetes mellitus are generally considered to be no more than inevitable annoyances and, as such, have been the subject of relatively few scientific and clinical studies. This review highlights both the known correlations between oral disease and diabetes mellitus, such as those involving supporting tissues and oral mucosa, and those that are still a matter of debate, such as dental caries. In all cases, we carefully analyzed the pathogenesis of the disorder with a view to establishing a possible therapeutic approach, an aspect that currently appears to be overlooked. In view of the fact that the treatment of certain oral conditions, in particular periodontal disease, has been reported to improve metabolic control in diabetic patients, we conclude that diabetes mellitus-related oral diseases deserve adequate recognition and further investigation.     

Diabetes mellitus and cardiovascular disease

Diabetes is associated with a high incidence and poor prognosis of cardiovascular disease, and with high short- and long-term mortality. Adequate treatment of cardiovascular disorders and aggressive management of coexisting risk factors have proved to be at least as effective in diabetic as in nondiabetic patients in randomized, controlled studies. Indeed, treating diabetic patients with cardiovascular disease results in a larger absolute risk reduction than in nondiabetic subjects. Nevertheless, diabetic patients often receive inadequate therapy, which may, to a certain extent, explain their poor prognosis. Recommendations for the treatment of diabetic patients with acute myocardial infarction should include beta-blockers, aspirin, and ACE-inhibitors in all patients in whom no specific contraindications exist. Fibrinolysis should be administered when indicated, and the benefits of improving glycemic control should not be forgotten either. In patients with multi-vessel disease who need revascularization, when selecting the type of procedure, the superiority of surgical revascularization over angioplasty should be borne in mind. Even heart transplantation should be included as a therapeutic option since there are no data to support the exclusion of patients on account of their diabetes. Finally, coexisting risk factors should be intensively treated through lifestyle intervention, with or without drug therapy, in order to achieve secondary prevention goals.     

Diabetes mellitus cerebrovascular disease

Cerebral vascular accident (CVA) is the second leading cause of deaths in developed countries. The mortality rate from CVA in the Czech Republic in people under 65 years is twice higher compared to countries in Western and Northern Europe. Every year it affects about 500/100,000 citizens with mortality within one year approximately in 45%. Incidence of this serious disease is three times more frequent in diabetics than in non-diabetics. After ictus, the prognosis is worse and repeated cerebral strokes more frequent. From the risk factors, diabetics usually suffer from hypertension which is part of a complex of metabolic syndrome X. There are more frequent carotid stenoses and impaired tiny arteries in diabetics compared to non-diabetic population. Recently, it has been pointed at an importance of early detection of hyperglycaemia in ischemic brain accidents, because hyperglycaemia seriously affects ischemic brain tissue. Apart from other things, it leads to impairment of motor functions. A specialist providing care to diabetics must consider and start treatment of all the risk factors. Under ideal conditions, every diabetic should be excellently compensated and have normal blood pressure values, low concentrations of LDL cholesterol, and should be treated with ACE inhibitor at the same time as with acetylsalicylic acid and clopidogrel.