[Abdomino-crural contracture disclosing panhypopituitarism with malnutrition]

Another case of flexion contracture in a 60 year-old patient with hypopituitarism, chronic alcoholism and starvation is reported. The contracture, as in the other cases, involved the lower limbs, but in this particular patient it extended to the abdominal and extensor neck muscles and neurological signs were associated: cerebellar atrophy and peripheral neuropathy of the lower limbs probably due to alcoholism. As in the other reported cases, severe hyponatremia was observed (105 mmol/l) the physiopathology of which is discussed: starvation and glucocorticoid deficiency alone or associated with aldosterone deficiency. The special feature of the anterior pituitary deficiency is that it is partly functional, at least with regards to the gonadotrophic secretion, perhaps related to the denutrition. The authors emphasize the necessity of searching for adrenal insufficiency in cases of abdomino-crural contracture because of the beneficial effects that result from hydrocortisone replacement therapy.