We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......

In Reply.—

Robert V. Farese, MD
Arch Intern Med. 1980;140(4):583-584. doi:10.1001/archinte.1980.00330160143057.
Text Size: A A A
Published online


We, too, considered the pathophysiologic explanation offered by Drs Phillips and Pain for our case, and this was discussed as the second of three explanations in the "Comments" section. The marked thyroidal response to TSH, however, clearly militated against a diagnosis of primary hypothyroidism. In addition, we remain convinced that the adrenal insufficiency is not owing to hypothalamic dysfunction secondary to hypothyroidism. First, the latter has not been described (the case report cited by Phillips and Pain was one of pituitary dysfunction), although admittedly theoretically possible. Second, our patient was only receiving 25 mg of cortisone each morning, and this should not have impaired the cortisol response to insulin hypoglycemia 48 hours after stopping such therapy.1 The suggestion to gradually reduce steroid therapy further for subsequent retesting seems hazardous and may invite a medical catastrophe.

As a final note, we are not sure that common diseases with uncommon


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.