propylthiouracil and Hypoglycemia

A 23-year-old man, on treatment for Graves' disease, presented to the emergency department, with 2 separate episodes of loss of consciousness. During the first episode, the initial serum glucose was 19 mg/mL, and 44 mg/dL during the second episode. The patient was non-diabetic, and had elevated blood insulin, C peptide and insulin antibody levels. His abdominal radiographic findings were normal. He was diagnosed with Hirata disease, and put on propylthiouracil as a replacement for carbimazole. Hypoglycaemia was managed with dextrose infusions and frequent meals. The patient's condition improved and he had no further episodes of hypoglycaemia during the follow-up period.

Topics: Blood Glucose; Carbimazole; Disease Management; Glucose; Graves Disease; Humans; Hypoglycemia; Male; Propylthiouracil; Young Adult

We report the case of a Caucasian patient with insulin autoimmune syndrome (IAS), defined as the association of hypoglycaemic attacks with insulin autoantibodies in individuals not previously treated with exogenous insulin. This rare syndrome (more than 200 published cases) has been reported mainly in Japan. Most affected patients present with other autoimmune disorders, most often Graves' disease. In most cases, insulin autoantibodies appear a few weeks after the beginning of treatment with a drug containing a sulphyldryl group. A significant increase in insulin and C-peptide plasma concentrations and the presence of other antiorgan antibodies are observed. The susceptibility haplotype is present in the Japanese population, which may account for the high frequency of IAS. Spontaneous remission is observed in 80% of cases, with cessation of hypoglycaemic attacks and disappearance of insulin autoantibodies some months after withdrawal of the drug. This rare cause of hypoglycaemia in Caucasian subjects should be considered in aetiologic investigation of spontaneous hypoglycaemia.

Topics: Antithyroid Agents; Autoantibodies; Autoimmune Diseases; C-Peptide; Carbimazole; Humans; Hyperthyroidism; Hypoglycemia; Insulin; Japan; Male; Middle Aged; Morocco; Paris; Propylthiouracil; Syndrome; White People

Topics: Acromegaly; Adrenocorticotropic Hormone; Aminoglutethimide; Bromocriptine; Calcitonin; Cushing Syndrome; Diazoxide; Diphosphonates; Estrogens; Fluid Therapy; Hemangiopericytoma; Humans; Hypercalcemia; Hyperthyroidism; Hypoglycemia; Inappropriate ADH Syndrome; Ketoconazole; Mifepristone; Mineralocorticoids; Mitotane; Octreotide; Osteomalacia; Pamidronate; Paraneoplastic Endocrine Syndromes; Phosphorus; Plicamycin; Propylthiouracil; Saline Solution, Hypertonic; Somatostatin; Thyroid Neoplasms

1. Adrenal TH activation was elicited in young rats (aged 4, 6 and 14 days) by insulin hypoglycaemia. In the control rats, TH activation varied between 125 and 147% above basal values. 2. Neonatal hypothyroidism induced by PTU treatment impaired TH activation. Compensatory treatment with T3 to the PTU-treated young rats led to a return to control activation.

Topics: Adrenal Glands; Animals; Enzyme Activation; Female; Hypoglycemia; Hypothyroidism; Insulin; Male; Propylthiouracil; Rats; Sodium Chloride; Thyroid Gland; Triiodothyronine; Tyrosine 3-Monooxygenase

Neonatal hypothyroidism accelerates the postnatal evolution of the adrenal dopamine (DA) content and concentration in the young rat. In 14-day-old control animals, insulin-hypoglycaemia leads to a transient increase in adrenal dopamine content up to 159% above the value in saline-injected animals. This increase is already at its maximum 1 h after insulin administration and lasts 7 h. In the hypothyroid animals, the DA increase evoked by hypoglycaemia is impaired in magnitude (74%) and duration (4 h).

Topics: Adrenal Glands; Animals; Animals, Newborn; Dopamine; Female; Hypoglycemia; Hypothyroidism; Insulin; Male; Propylthiouracil; Rats; Rats, Inbred Strains; Thyroid Gland; Triiodothyronine

The adrenal medulla of normal, hypothyroid and hyperthyroid young rats was stimulated by insulin-induced hypoglycaemia. In normal rats, insulin-induced adrenal epinephrine secretion increases during the first 10 days of post-natal life. Hypothyroidism retards the development of adrenal response; hyperthyroidism facilitates the development of this response. At 14 days, when insulin-induced adrenal epinephrine depletion is the same for all groups, the recovery of adrenal catecholamines stores after depletion is linear and takes less than 48 h. Recovery rate is slightly slower for hyperthyroid rats than for either hypothyroid or control rats at 14 days. Following epinephrine depletion, adrenal tyrosine hydroxylase (TH) and dopamine-beta-hydroxylase (DBH) activities are increased for a few days in the control rats, corresponding to a transsynaptic induction. Hypothyroidism impairs TH induction and completely suppresses DBH induction; hyperthyroidism impairs TH induction, but has no effect on DBH induction. These data show that the various processes related to CA synthesis, in the adrenal medulla of the developing rat, are controlled in different ways by the thyroid hormones.

Topics: Adrenal Medulla; Animals; Animals, Newborn; Body Weight; Catecholamines; Dopamine beta-Hydroxylase; Epinephrine; Hypoglycemia; Insulin; Propylthiouracil; Rats; Rats, Inbred Strains; Thyroid Hormones; Time Factors; Tyrosine 3-Monooxygenase

At 14 days of age, hypothyroid and normal rats are rendered hypoglycaemic by insulin injection and the subsequent induction in adrenal tyrosine hydroxylase (TH) is studied. Hypothyroidism impairs both the intensity and the time-course of adrenal TH induction.

Topics: Adrenal Glands; Animals; Enzyme Induction; Female; Hypoglycemia; Hypothyroidism; Insulin; Kinetics; Male; Propylthiouracil; Rats; Thyroid Hormones; Tyrosine 3-Monooxygenase