The Genie in the Bottle

In the fall of 1992, my 1-year-old granddaughter developed classic erythema infectiosum. Her face took on the typical “slapped cheek” appearance, and she developed fever and malaise. I suspected that her parvovirus B19 would in all likelihood infect her grandfather, and it did: I developed fever and severe joint pains. Even after these symptoms disappeared, however, I felt poorly and could never seem to recover from an increasing sense of fatigue that persisted and even worsened. In 6 weeks, my hemoglobin concentration decreased to 10 g (possibly due to the parvovirus), and I lost 22 pounds. I had no appetite, despite my wife's best efforts to provide me with my favorite dishes. I simply could not eat more than several hundred calories a day.

I was hospitalized with a working diagnosis of possible pancreatic cancer. I was cachectic and extremely weak. The only clinical finding other than the recent weight loss was a systolic blood pressure of 80 mm Hg, which responded to vigorous hydration. This prompted a very astute clinician to think that the problem might be metabolic, and he called for a cortisol level. It came back at just about zero. Several studies later, an enlarged sella with a 2.5-cm mass was diagnosed and I was prepared for a transphenoidal hypophysectomy.

During this time, my missing hormones were replaced and I developed a ferocious appetite. But …