Long-term dobutamine in heart failure.

This patient has cranial diabetes insipidus and hypoparathyroidism with low serum testosterone level and normal range FSH and LH. There was no evidence of granulomatous diseases, histiocytosis or sarcoidosis despite a history ofpolyuria for more than 10 years, although these may take years to manifest2 and diabetes insipidus may be an early manifestation. However, as has been reported,' about 30% of these patients have antibodies against vasopressin-secreting cells in the hypothalamus. The hypocalcaemia and hyperphosphataemia with serum parathyroid hormone levels (mid-molecule RIA), inappropriately low for the level of calcium, indicate hypoparathyroidism which again on clinical grounds appears to be sporadic and idiopathic, and for which the most likely cause is autoimmune. He also had normal secondary sexual features with borderline low serum testosterone which could indicate the later development of hypogonadotrophic hypogonadism in which usually there is a hypothalamic defect in gonadotrophin releasing hormone release3 and is not commonly associated with disorders of other hypothalamic hormone secretion4 including diabetes insipidus.