著者

笠置 智道 高見 和久 山田 明子 坂井 聡美 原 高志 酒井 勝央 安田 圭吾 今井 裕一

出版者

一般社団法人 日本糖尿病学会

雑誌

糖尿病 (ISSN:0021437X)

巻号頁・発行日

vol.58, no.5, pp.336-341, 2015-05-30 (Released:2015-06-01)

参考文献数

11

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症例はうつ病の36歳女性.糖尿病は未診断.入院1週間前より食事をせず飲酒のみの生活が続き,反復する嘔吐と共に意識状態が悪化し救急搬送された.糖尿病性ケトアシドーシスと診断しインスリン持続投与を開始.それに伴い血清K値は入院時の2.7 mEq/lから1.3 mEq/lまで低下したため,インスリン投与を一時中断しその間72時間で計660 mEqのKを補充した.その後血中ケトン体は減少するもアシデミアがさらに進行し,低Alb血症,低P血症を伴い複雑な酸塩基平衡異常を呈した.Stewartのphysicochemical approachにより酸塩基平衡を解析すると,強イオン性代謝性アシドーシスが主体で,原因として希釈,大量食塩水負荷,急性尿細管障害,ケトン体尿排泄の関与が示唆された.種々の電解質の欠乏を伴った酸塩基,水電解質平衡を総合的に理解するためにStewart法が有用であった.

著者

森 昭裕 梶田 和男 山北 宜由 森田 浩之 村井 敏博 安田 圭吾 杉浦 正彦 三浦 清

出版者

一般社団法人 日本内分泌学会

雑誌

日本内分泌学会雑誌 (ISSN:00290661)

巻号頁・発行日

vol.67, no.10, pp.1147-1161, 1991-10-20 (Released:2012-09-24)

参考文献数

23

被引用文献数

1 1

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Recently several types of anti-pituitary-antibodies (APA) have been found in patients with pituitary disorders including hypopituitarism and diabetes incipidus, and in postpartum women. However, the pathophysiological role(s) of APA still remains unknown. In order to elucidate the clinical significance of APA, longitudinal follow-up and family study of APA in patients with hypopituitarism were performed.APA in serum was examined in a total of 11 patients with various types of hypopituitarism (7 of isolated ACTH deficiency, 1 of partial hypopituitarism, 3 of Sheehan's syndrome, 6 males and 5 females). Chronic thyroiditis was associated in 3 out of 7 patients with isolated ACTH deficiency, and empty sella was found in each one patient with isolated ACTH deficiency and partial hypopituitarism, and in 3 patients with Sheehan's syndrome. APA was examined on 2 or 3 occasions at more than a 6 month interval (longitudinal study). In 5 patients, their 16 family members were examined for the presence of APA, and pituitary functions were evaluated in 3 out of 7 family members with positive APA (family study). For pituitary function tests, arginine infusion test, TRH, LH-RH or CRH test and insulin tolerance test were performed. APA reacting to rat pituitary cytoplasmic antigens (pituitary cell antibodies: PCA) and APA reacting to rat GH3 cells and/or mouse AtT20 cells surface antigens (pituitary cell surface antibodies: PCSA) were assayed with indirect immunofluorescence method.At the initial examination, 6 out of 11 patients (55%) showed positive APA. Thepatients were divided into 3 subgroups according to the longitudinal study: the group with disappearance of initially positive APA (3 patients), the group with altered titers or types of initially positive APA (3 patients), and the group with sustained initially negative APA (4 patients). No effects of replacement therapy on the alterations of APA were observed.In 16 family members of 5 patients (each 1 with partial hypopituitarism and isolated ACTH deficiency syndrome, and 3 with Sheehan's syndrome), APA in their sera were investigated. Seven out of 16 members (44%) showed positive APA. Among 6 first-degree relatives of 16 family members, both or either one of APA and PCSA were positive in 4 (67%). Out of 10 of their second- or third-degree relatives, 3 (30%) were positive for PCA or PCSA. All of 3 relatives with positive APA studied showed mild pituitary hypofunction without any clinical manifestations.These results suggest the possibility that autoimmune mechanism-induced hypofunction as well as hereditary background might participate in the pathogenesis of some hypopituitarism, and that APA might have a causative role in such disorders.

著者

武田 則之 安田 圭吾 林 慎 後藤 忍 青山 かおり 伊藤 康文 堀谷 登美子 北田 雅久 野津 和巳 岡 暢之 加藤 譲 三浦 清

出版者

THE JAPAN DIABETES SOCIETY

雑誌

糖尿病 (ISSN:0021437X)

巻号頁・発行日

vol.32, no.10, pp.767-771, 1989

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症例は23歳女性.1983年9月一過性のthyrotoxicosisで受診.禰漫性の甲状腺腫を認め, 抗甲状腺マイクロゾーム抗体 (MCHA) 陽性.759経口糖負荷試験で血糖前値137mg/d<I>l</I>, 2時間値271mg/d<I>l</I>.1年後妊娠し, 1984年12月帝王切開で女児出産.妊娠中free thyroxine値は正常でMCHAの抗体価は低下した.妊娠中インスリンを使用したが, 産後にSU剤に変更出産3ヵ月後にpostpartum thyroiditisによると考えられるthyrotoxicosisと糖尿病性ケトアシドーシス (DKA) を同時に発症.DKA改善後も1日30単位以上のインスリンを必要とした.抗ラ氏島細胞抗体 (ICA) は妊娠中も出産後も持続性に陽性.血中C-peptide基礎値は妊娠18週0.4ng/m<I>l</I>, 26週0.7ng/m<I>l</I>であったが, DKA発症以後は測定感度以下で, グルカゴン試験時のC-peptide反応頂値も0.7ng/m<I>l</I>と低値HLADR4を有していた.本例はNIDDMの病像で発見され, 産後にIDDMの病像が顕性化した症例と考えられた.妊娠, 出産に伴う免疫機能の変動と, IDDMの進展との関連, が示唆された.