Diabetes and Anterior Pituitary Insufficiency: Final Course and Postmortem Study of a Diabetic Patient with Sheehan's Syndrome

Abstract

The final course and postmortem of a patient with diabetes and anterior pituitary insufficiency are presented. The preliminary report of this case with recovery from retinopathy was published in 1953. The retinopathy had not reappeared when the patient died in uremia in 1960. From 1951, substitution treatment with cortisone and thyroid was given. The postmortem was typical for anterior pituitary insufficiency due to postpartum pituitary necrosis (Sheehan's syndrome). The anterior pituitary was mainly substituted by fibrous tissue and the adrenal cortices were atrophic. Microscopic examination of the eyes did not show obvious signs of diabetic retinopathy after thirty-six years of diabetes and fifteen years after retinal hemorrhages and the onset of pituitary insufficiency. The results of postmortem examination of other organs did not differ from the usual findings in cases of juvenile diabetes dying in uremia. The advisability of hypophysectomy for the palliation of diabetic retinopathy is discussed, and it is suggested that a closer examination of the influence of growth hormone on retinal metabolism and vascular function may be of interest. Perhaps the recently demonstrated unmyelinated fibers in the optic nerve coming from the pituitary stalk will be shown to have an influence on the vascular regulation of the retina, and on the pathogenesis of retinopathy; if so, these fibers may explain why only the retinopathy and not the other late manifestations of diabetes seem to benefit from ablation of pituitary function.