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Rheumatology 2007 46(1):92; doi:10.1093/rheumatology/kel304
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© The Author 2006. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

An unusual association with Raynaud's phenomenon

Maria AL-Deiri1, Jonathan J. Benn1 and Chris M. Deighton1

1Derbyshire Royal Infirmary, Department of Rheumatology, Derby, Derbyshire and 2Burton Hospitals NHS Trust, Department of Medicine, Burton-on-Trent, Staffordshire, UK.

Correspondence to: C. M. Deighton. E-mail: chris.deighton{at}derbyhospitals.nhs.uk

A 36-yr-old lady with a year of typical Raynaud's and polyarthralgia had a normal examination other than cold peripheries and blood pressure of 90/60 mmHg and no evidence of connective tissue disease. Her haemoglobin was 10.3 g/dl and sodium 127 mmol/l (135–145), but other tests, including thyroid stimulating hormone (TSH) and immunology, were normal. Six months later she was reviewed and remarkably improved. She reported that in the intervening time an endocrinologist had investigated episodes of collapse, fatigue and dizziness. She had been well until the delivery of her only child 3 yrs ago. There was significant postpartum bleeding. Following this she lost her pubic hair, libido and was unable to breast feed. She was being investigated for premature menopause. She had an abnormal short synacthen test, low free T3 and T4, gonadotrophin and growth hormone. An MRI showed atrophy of the pituitary gland suggesting a previous infarction (Fig. 1) Panhypopituitarism (Sheehan's syndrome) was diagnosed. On starting hydrocortisone, thyroxine and the oral contraceptive her Raynaud's settled. We have only found one other similar case in the literature [1]. A list of conditions associated with Raynaud's in Hochberg et al. 's [2] Rheumatology mentions hypothyroidism, but not panhypopituitarism. Rheumatologists should be aware of this rare association.


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  		FIG. 1. Sagittal MRI scan with contrast demonstrating the pituitary atrophy (arrow).

 
There is no conflict of interest or source of funding.


   References
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  1. Shagan BP and Friedman SA. (1980) Raynaud's phenomena and thyroid deficiency. Arch Int Med 40:823–33.
  2. Al-Allaf A-W and Belch JJF. (2003) Raynaud's phenomenon. In Hochberg MC, Silman AJ, Smolen JS, Weiblatt ME, Weisman MH (Eds.). Rheumatology(Mosby, Edinburgh) pp. 1507–12.

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K. A. Binymin
An unusual association with Raynaud's phenomenon
Rheumatology, May 1, 2007; 46(5): 894 - 894.
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