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It is well recognised that in patients with pituitary insufficiency thyroid hormone replacement without concomitant adrenal steroid replacement may precipitate an acute adrenal crisis.' It is less widely appreciated that similar problems may arise during treatment of primary myxoedema if the patient also has unrecognised or subclinical adrenocortical disease. We report on two patients with primary hypothyroidism in whom thyroxine replacement precipitated an acute addisonian crisis.
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Fonseca et al. (1986) studied this question.
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