We report a case of flexion
contractures in a patient's legs secondary to
postpartum hypopituitarism. A 56-year-old woman presented with a 3-year history of worsening flexion
contractures of the hips and knees. On admission, her hips and knees could not be extended, and she had muscle stiffness and tenderness to palpation of the lower extremities. We first suspected
stiff-person syndrome or
Isaacs' syndrome because of her muscle stiffness. However, multiple
hormones did not respond to stimulation tests, and an MRI of the brain showed
atrophy of the pituitary gland with an empty sella. A subsequent interview revealed that she had suffered a severe
hemorrhage while delivering her third child. She was diagnosed with
panhypopituitarism and started on
cortisol replacement
therapy. After 1 week of treatment with
hydrocortisone (10 mg/day), her symptoms quickly improved. We then added 75 μg/day of
thyroid hormone. During the course of her treatment,
autoantibodies against VGKC complex were found to be weakly positive. However, we considered the
antibodies to be unrelated to
her disease, because her symptoms improved markedly with low-dose
steroid treatment. There are a few reports describing flexion
contractures of the legs in patients with primary and secondary
adrenal insufficiency. As these symptoms are similar to those seen in
stiff-person syndrome, adrenal and
pituitary insufficiency should be taken into account to achieve the correct diagnosis and treatment in patients with flexion
contractures and muscle stiffness.