Yentl's syndrome in Croatia: Younger male patients from capital were favoured for PCI

stroke is occasionally accompanied by CTEPH [4]. IAD can thus be a result of post-traumatic brain injury, Sheehan's syndrome, empty sella syndrome, and after radiation therapy for brain tumour [3]. Even though pituitary MRI did not reveal a pituitary infarction or haemorrhage in these patients, it remains possible that a pituitary circulatory disorder, such as a pituitary microinfarction, occurred. IAD may therefore be triggered by PGI2 therapy. PAH and CTEPH are occasionally associated with thyroid disease [4,6]. Ferris et al. noted that PGI2 therapy may be associated with development of thyroid disease [6]. Twenty-six of 134 patients with PAH had thyroid disease and 20 of those were undergoing PGI2 therapy in their report [6]. Five patients, including present two cases, were treated with PGI2 among over 200 cases of CTEPH in this department. None of the patients who were not treated with PGI2 therapy developed IAD, suggesting that PGI2 therapy might be associated with IAD. In conclusion, these cases suggest that CTEPH or PGI2 therapy, or both, may be associated with the development of IAD, although the mechanisms of these associations still remain undefined. ACTH deficiency should therefore be considered in the differential diagnosis when CTEPH patients, as well as patients undergoing PGI2 therapy, manifest an unexplained deterioration in symptoms. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [7, 8].