Hypophysectomy:Relation between stress and cause of death

A 63-years-old man was found dead with the body soaking in water lying face up on a riverbank. Autopsy and diatom examination demonstratedthatthecauseofdeathwasdrowning. He had undergone hypophysectomy 20years earlier. Autopsy, pathological and endocrinological findings demonstrated secondary and chronic hypothyroidism, hypogonadism, and adrenal insufficiency.Thecadaverhadfallenintotheriver,andreceivednumerouswoundssuchasabrasions and subcutaneous hemorrhage. Moreover, it was suspected that hehad developed hypothermia before death. Cortisol in the blood and 17OHCS in urine were within the reference range. We suspect that the adrenocortical hormone was secreted into the blood as a result of various stresses due to wounds and hypothermia. However, it was suspected that sufficient hormone might not be secreted due to chronic adrenal insufficiency. This insufficient cortisol causes the decrease in the stress resistance, and might influence his cause of death. Moreover, as hypothyroidism decreases thermogenesis, he might have fallen into hypothermia easily. In addition, becauseboth adrenocortical insufficiency and hypothyroidismcausedthehypoglycemia, he might have fallen into the loss of consciousness. Therefore, it was considered that hehad died by drowning, in relation to the adrenocortical insufficiency and panhypopituitarism. J. Med. Invest. 53 : 183-187, February, 2006