From the bronze age to the iron age

A 53 year old man, without any previous medical history, presented acutely to the Accident and Emergency Department with a 5 day history of vomiting and abdominal pain on a background of weight loss, fatigue, polyuria and polydipsia for 4 weeks. On examination he was obviously tanned and thin. He was clinically dehydrated and had palpable hepatomegaly. Immediate biochemical testing revealed hyperglycaemia with a venous blood glucose of 20.7 mmol/l, a metabolic acidosis with a pH of 7.1 (and venous bicarbonate of 11.3 mmol/l) and significant ketonuria (++++) thus confirming the clinical suspicion of diabetic keto-acidosis (DKA). His serum ferritin levels were markedly raised at 11346 ug/l with a raised transferrin saturation of 92%. His initial basal pituitary function showed evidence of partial anterior hypopituitarism. This was manifest by hypogonadotrophic hypogonadism with an FSH of