Aron, Schnall, and Sheeler
renal mass. The interpretation of the computerized tomographic scan and tomograms of the sella turcica is complicated by the physiologic increase in pituitary size during pregnancy. Our patient had a clinical and biochemical remission post partum. Intermittent Cushing's syndrome and spontaneous remissions have occurred in nonpregnant patients with Cushing's disease, adrenal tumors, and ectopic adrenocorticotropic hormone syndrome. Corticotropin-releasing factor (CRF) has been found in the placenta; plasma CRF levels rise during pregnancy, reaching very high values at term, and abruptly fall after delivery. While the role of placental CRF in the physiologic regulation of the hypothalamic-pituitaryadrenal axis is unknown, placental CRF may playa role
February 1990 Am J Obstet Gynecol
in the exacerbation of Cushing's syndrome and the postpartum fall in CRF might account for the spontaneous remission observed in this case and others. Dynamic testing in 1988 revealed no abnormality of the hypothalamic-pituitary-adrenal axis. Whether the patient had an underlying subtle abnormality of the hypothalamic-pituitary axis to which hypersecretion of placental CRF contributed is not known. REFERENCES I. Calodney L, Eaton RP, Black W, Cohn F. Exacerbation of Cushing's syndrome during pregnancy: report of a case. 1 Clin Endocrinol Metab 1973;36:81-6. 2. Reschini E, Giustine G, Crosignani PG, D'alberton A. Spontaneous remission of Cushing syndrome after termination of pregnancy. Obstet Gynecol 1978;5:598-602.
Insulin-dependent diabetes mellitus associated with danazol David B. Seifer, MD, Lisa N. Freedman, MD,Johanna R. Cavender, MD, and Rebecca A. Baker, MD Syracuse, New York Insulin-dependent diabetes mellitus developed in a young woman 8 weeks after the initiation of danazol for treatment of pelvic endometriosis. After discontinuation of danazol the diabetes completely resolved. We suspect a possible cause-and-effect relationship, which has not previously been reported in the literature. (AM J OBSTET GVNECOL 1990;162:474-5.)
Key words: Danazol, diabetes mellitus, glucose intolerance, hyperandrogenism
Reported is a case of insulin-dependent diabetes mellitus associated with the use of danazol for the treatment of pelvic endometriosis. Initial appearance and subsequent resolution of diabetes mellitus were clearly temporally related to the start and discontinuation of this medication. Obvious signs and symptoms of overt diabetes mellitus developed and insulin therapy was required. To our knowledge, this is the first reported occurrence of this association. From the Department of Obstetrics and Gynecology, State University of New York Health Science Center. Received for publicatIOn May 22, 1989; revISed July 31, 1989; accepted August 7, 1989. Reprint requests: David B. Seifer, MD, Department of Obstetrics and Gynecology, Yale Unlverszty School of Medicine, 333 Cedar St., P.O. Box 3333, New Haven, CT 06510. 6/1/15884
474
Case report A 26-year-old, white, nulligravid woman was seen initially in November 1987 complaining of failure to conceive after 6 months of unprotected intercourse, in addition to dysmenorrhea since age 20. Her gynecologic history was unremarkable with menarche at age 17 and menses occurring regularly every 30 days. Physical examination showed a well-developed, normotensive woman, whose height was 5 feet 7 inches and weight 130 pounds. There was no evidence of hirsutism or galactorrhea. Pelvic examination was normal. She was instructed to keep basal body temperature charts and to continue unprotected coitus. In October 1988 she underwent laparoscopy because of suspected pelvic inflammatory disease, at which time she was found to have stage III endometriosis. Laboratory values during this admission included random blood glucose levels of 116 and 79 mg / dl. Danazol 400 mg bj.d.
Diabetes associated with danazol
Volume 162 Number 2
was started in early November 1988. She developed amenorrhea within 4 weeks of starting danazol and was without any expected side effects from the medication. Dysmenorrhea and pelvic pain greatly improved during the next 2 months. In early January 1989 she began noticing progressive polyphagia, polydipsia, and polyuria in addition to malaise, fatigue, nausea, and blurry vision. She had lost 2 pounds and had been treated for two yeast infections during the previous month. In February 1989 she sought medical care, at which time she denied a history of diabetes mellitus or other endocrine disorders. There was no family history of diabetes and the patient had not had similar symptoms in the past. A fasting blood glucose level of 290 mg/dl and a 2-hour postprandial blood glucose level of660 mg/dl were noted. Liver function test results were within normal limits and cholesterol was unchanged. At this point there was concern that danazol might be related to the recent onset of diabetes, and thus it was discontinued on Feb. 7, 1989. The next day the patient was examined by an internist, who began her on a 2200-calorie American Diabetes Association diet, as well as lente insulin 15 units plus 5 units of regular insulin every morning and 15 units of regular insulin every evening. Blood glucose levels were monitored by the patient q.i.d. using AccuCheck II and initially ranged between 180 and 240 mg/dJ. After 10 days, she noted great symptomatic improvement with blood glucose levels ranging between 100 and 130 mg/dJ. Four weeks later, in early March, the insulin was discontinued on a trial basis. By the second week of March, she discontinued the American Diabetes Association diet. Several follow-up visits have documented postprandial blood glucose levels to be
renal mass. The interpretation of the computerized tomographic scan and tomograms of the sella turcica is complicated by the physiologic increase in pituitary size during pregnancy. Our patient had a clinical and biochemical remission post partum. Intermittent Cushing's syndrome and spontaneous remissions have occurred in nonpregnant patients with Cushing's disease, adrenal tumors, and ectopic adrenocorticotropic hormone syndrome. Corticotropin-releasing factor (CRF) has been found in the placenta; plasma CRF levels rise during pregnancy, reaching very high values at term, and abruptly fall after delivery. While the role of placental CRF in the physiologic regulation of the hypothalamic-pituitaryadrenal axis is unknown, placental CRF may playa role
February 1990 Am J Obstet Gynecol
in the exacerbation of Cushing's syndrome and the postpartum fall in CRF might account for the spontaneous remission observed in this case and others. Dynamic testing in 1988 revealed no abnormality of the hypothalamic-pituitary-adrenal axis. Whether the patient had an underlying subtle abnormality of the hypothalamic-pituitary axis to which hypersecretion of placental CRF contributed is not known. REFERENCES I. Calodney L, Eaton RP, Black W, Cohn F. Exacerbation of Cushing's syndrome during pregnancy: report of a case. 1 Clin Endocrinol Metab 1973;36:81-6. 2. Reschini E, Giustine G, Crosignani PG, D'alberton A. Spontaneous remission of Cushing syndrome after termination of pregnancy. Obstet Gynecol 1978;5:598-602.
Insulin-dependent diabetes mellitus associated with danazol David B. Seifer, MD, Lisa N. Freedman, MD,Johanna R. Cavender, MD, and Rebecca A. Baker, MD Syracuse, New York Insulin-dependent diabetes mellitus developed in a young woman 8 weeks after the initiation of danazol for treatment of pelvic endometriosis. After discontinuation of danazol the diabetes completely resolved. We suspect a possible cause-and-effect relationship, which has not previously been reported in the literature. (AM J OBSTET GVNECOL 1990;162:474-5.)
Key words: Danazol, diabetes mellitus, glucose intolerance, hyperandrogenism
Reported is a case of insulin-dependent diabetes mellitus associated with the use of danazol for the treatment of pelvic endometriosis. Initial appearance and subsequent resolution of diabetes mellitus were clearly temporally related to the start and discontinuation of this medication. Obvious signs and symptoms of overt diabetes mellitus developed and insulin therapy was required. To our knowledge, this is the first reported occurrence of this association. From the Department of Obstetrics and Gynecology, State University of New York Health Science Center. Received for publicatIOn May 22, 1989; revISed July 31, 1989; accepted August 7, 1989. Reprint requests: David B. Seifer, MD, Department of Obstetrics and Gynecology, Yale Unlverszty School of Medicine, 333 Cedar St., P.O. Box 3333, New Haven, CT 06510. 6/1/15884
474
Case report A 26-year-old, white, nulligravid woman was seen initially in November 1987 complaining of failure to conceive after 6 months of unprotected intercourse, in addition to dysmenorrhea since age 20. Her gynecologic history was unremarkable with menarche at age 17 and menses occurring regularly every 30 days. Physical examination showed a well-developed, normotensive woman, whose height was 5 feet 7 inches and weight 130 pounds. There was no evidence of hirsutism or galactorrhea. Pelvic examination was normal. She was instructed to keep basal body temperature charts and to continue unprotected coitus. In October 1988 she underwent laparoscopy because of suspected pelvic inflammatory disease, at which time she was found to have stage III endometriosis. Laboratory values during this admission included random blood glucose levels of 116 and 79 mg / dl. Danazol 400 mg bj.d.
Diabetes associated with danazol
Volume 162 Number 2
was started in early November 1988. She developed amenorrhea within 4 weeks of starting danazol and was without any expected side effects from the medication. Dysmenorrhea and pelvic pain greatly improved during the next 2 months. In early January 1989 she began noticing progressive polyphagia, polydipsia, and polyuria in addition to malaise, fatigue, nausea, and blurry vision. She had lost 2 pounds and had been treated for two yeast infections during the previous month. In February 1989 she sought medical care, at which time she denied a history of diabetes mellitus or other endocrine disorders. There was no family history of diabetes and the patient had not had similar symptoms in the past. A fasting blood glucose level of 290 mg/dl and a 2-hour postprandial blood glucose level of660 mg/dl were noted. Liver function test results were within normal limits and cholesterol was unchanged. At this point there was concern that danazol might be related to the recent onset of diabetes, and thus it was discontinued on Feb. 7, 1989. The next day the patient was examined by an internist, who began her on a 2200-calorie American Diabetes Association diet, as well as lente insulin 15 units plus 5 units of regular insulin every morning and 15 units of regular insulin every evening. Blood glucose levels were monitored by the patient q.i.d. using AccuCheck II and initially ranged between 180 and 240 mg/dJ. After 10 days, she noted great symptomatic improvement with blood glucose levels ranging between 100 and 130 mg/dJ. Four weeks later, in early March, the insulin was discontinued on a trial basis. By the second week of March, she discontinued the American Diabetes Association diet. Several follow-up visits have documented postprandial blood glucose levels to be
