Atypical thyroid tests in an athlete treated for hypothyroidism as the first symptom of pituitary dysfunction due to relative energy deficiency.

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM Endocrinology, Diabetes and Metabolism Case Reports Pub Date : 2024-10-29 Print Date: 2024-10-01 DOI:10.1530/EDM-24-0066
Monika Skrzypiec-Spring, Justyna Kuliczkowska-Płaksej, Adam Szeląg, Marek Bolanowski
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Abstract

Summary: Relative energy deficiency in sport occurs in athletes who have limited energy availability. Its typical features include reversible suppression of the hypothalamic-pituitary-gonadal axis. In addition, it may be accompanied by hepatic resistance to growth hormone, leading to a decrease in insulin-like growth factor 1 and dysregulation of the hypothalamic-pituitary-thyroid axis. We present the clinical case of a 33-year-old athlete previously treated effectively for hypothyroidism, who presented with low thyroid-stimulating hormone, low free triiodothyronine, and normal free thyroxine. Based on diet and training interviews and further laboratory tests, dysregulation of the hypothalamic-pituitary-thyroid axis and reversible hypogonadism due to insufficiency of energy available to support energy expenditure were revealed. We also discuss here challenging diagnostic dilemmas that may appear in athletes of normal body weight but result from insufficient energy supply in relation to demand, and review the literature for the clinical course and possible mechanisms underlying the relative energy deficiency.

Learning points: Atypical thyroid function tests in athletes may be the first manifestation of reversible pituitary dysfunction due to relative energy deficiency. Typical symptoms of relative energy deficiency include reversible suppression of the hypothalamic-pituitary-thyroidal axis and hypothalamic-pituitary-gonadal axis. Relative energy deficiency may occur in all people who train intensively, regardless of their body weight and BMI, as well as in people who have rapidly lost weight as a result of a low-calorie diet and intense exercise.

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一名运动员因能量相对不足导致垂体功能障碍而出现甲状腺机能减退的首发症状,并接受了非典型甲状腺检测。
摘要运动中的相对能量缺乏症发生在能量供应有限的运动员身上。其典型特征包括下丘脑-垂体-性腺轴的可逆性抑制。此外,还可能伴有肝脏对生长激素的抵抗,导致胰岛素样生长因子 1 减少和下丘脑-垂体-甲状腺轴调节失调。我们介绍了一个临床病例,患者是一名 33 岁的运动员,之前曾接受过有效的甲状腺功能减退症治疗,但出现促甲状腺激素低、游离三碘甲状腺原氨酸低和游离甲状腺素正常的症状。根据饮食和训练访谈以及进一步的实验室检查,发现下丘脑-垂体-甲状腺轴调节失调,以及由于支持能量消耗的能量不足而导致的可逆性性腺功能减退症。在此,我们还讨论了可能出现在体重正常的运动员身上,但由于能量供应不足而导致的诊断难题,并回顾了有关临床过程和能量相对不足的可能机制的文献:学习要点:运动员的非典型甲状腺功能检查可能是相对能量缺乏导致的可逆性垂体功能障碍的最初表现。相对能量缺乏的典型症状包括下丘脑-垂体-甲状腺轴和下丘脑-垂体-性腺轴的可逆性抑制。所有进行高强度训练的人,无论其体重和体重指数如何,以及因低热量饮食和高强度运动而迅速减肥的人,都可能出现相对能量缺乏症。
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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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