Co-Occurrence of Multiple Endocrine Abnormalities Induced by the DIHS/DRESS
Table 1
Three cases of co-occurrence of FT1DM and HT in PUMCH during January 2012 to December 2017.
Case 1
Case 2
Case 3
Age
25
33
25
Gender
Male
Female
Female
DIHS/DRESS syndrome
Causative drugs
Unknown
Unknown
Oxcarbazepine
Fever > 38.5°C
Yes
Yes
Yes
Rashes
Yes
Yes
Yes
Eosinophils
1.45 × 109/L
5.45 × 109/L
0.74 × 109/L
Other organs involvement
ALT 301 U/L, Cr 485 μmol/L
ALT 206 U/L, Cr 181 μmol/L
ALT 273 U/L
Systemic corticosteroid therapy (mg/day) or IVIG
Irregular use of systemic glucocorticoid for one month (started with methylprednisolone 80 mg iv qd)
Methylprednisolone 40 mg iv qd
Methylprednisolone 40 mg iv qd for 5 days, then 40 mg po qd
Diabetes mellitus
Diagnosis
FT1DM
T1DM
FT1DM
Interval of time#
2 months
3 months
4 months
Onset by DKA
Yes
Yes
Yes
HbA1c (%)
7.8%
10.58%
8.6%
Fasting C peptide (ng/mL)
<0.05
<0.05
<0.05
IA-2Ab (IU/mL)
0.57
0.87
0.57
ICA-IgG
Negative
Negative
Negative
GAD (IU/mL)
2.33
>2000
6.00
IAA (IU/mL)
11.26
4.63
22.22
Autoimmune thyroid disease
Diagnosis
HT
HT, PTC
HT
Interval of time
9 months
53 months
9 months
Thyroid function test
Primary hypothyroidism
Normal
Normal
A-Tg (IU/ml)
18.00
494.60
278.60
A-TPO (IU/ml)
73.50
>600.00
150.40
Hypothalamic-pituitary-adrenal axis
ACTH (8AM) (pg/ml)
35.2
ND
24.4
Cortisol (8AM) (μg/dl)
18.35
ND
15.11
GH-IGF1 axis
GH (ng/ml)
0.1
ND
ND
IGF1 (ng/ml)
252
205
236
Gonadal hormone
LH (IU/L)
7.64
11.66
4.18
FSH (IU/L)
23.35
23.54
10.07
T (ng/ml) or E2 (pg/ml)
4.94
45.29
59.93
Hypoparathyroidism
No
No
No
ND: no data. Measured by the radioligand-binding assay (RBA); #the resolution of DIHS/DRESS and the onset of DM or AITD. Normal range: IA-2Ab 0.00–1.00 IU/mL; GAD 0.00–5.00 IU/mL; IAA 0.00–0.40 IU/mL; A-Tg < 115 IU/mL; A-TPO < 34 IU/mL.
