Complete heart block caused by primary Sjögren’s syndrome and hypopituitarism

Serum concentrations of free thyroxine (7.1 pmol/l (normal 9.0â[euro]"24.5)), free triiodothyronine (4.8 pmol/l (normal 3.4â[euro]"7.00)), thyrotropin basal (1.1 mU/l (normal 0.17â[euro]"2.9)), and basal prolactin (2.1 ng/ml (normal 2â[euro]"20) were near normal, whereas the stimulation with thyrotropin releasing hormone was blunted for thyrotropin (1.76 mU/l) and prolactin (2.3 ng/ml), indicating a final insufficiency of these regulatory pathways. [...]increased antibody titres against smooth muscle (1:8) and against parietal cells (1:4) were indicative of autoimmune hypophysitis. 6 Computed tomography did not show any pituitary abnormalities. Because of the implanted pacemaker, magnetic resonance imaging could not be performed.