Elsevier

Endocrine Practice

Volume 7, Issue 2, March 2001, Pages 102-105
Endocrine Practice

Case Report
Isolated Adrenocorticotropic Hormone Deficiency, Thyroid Autoimmunity, And Transient Hyperprolactinemia

https://doi.org/10.4158/EP.7.2.102Get rights and content

ABSTRACT

Objective

To describe a case of isolated adrenocorticotropic hormone (ACTH) deficiency associated with thyroid autoimmunity, subclinical hypothyroidism, and transient hyperprolactinemia.

Methods

We present a detailed case report, including results of laboratory studies and magnetic resonance imaging, and discuss potential contributing factors in this setting.

Results

In a 23-year-old woman with isolated ACTH deficiency accompanied by thyroid autoimmunity (Hashimoto’s thyroiditis), subclinical primary hypothyroidism, and hyperprolactinemia, magnetic resonance imaging of the pituitary showed normal findings but dynamic stimulation testing of the pituitary gland indicated an isolated ACTH deficiency with intact growth hormone and gonadotropin secretory reserves. The cortisol response to the short ACTH stimulation test was subnormal. Therapy with prednisolone (5 mg/day) and levothy- roxine (100 pg/day) was initiated. Results of thyroid function tests were normalized after 1 month, the prolactin level decreased to normal after 1 year, and titers of thyroid autoantibodies decreased substantially after 1.5 years of treatment.

Conclusion

The correction of the related glucocorticoid deficiency resulted in resolution of the hyperprolactinemia and a decrease in titers of thyroid autoantibodies. (Endocr Pract. 2001;7:102-105)

Section snippets

INTRODUCTION

Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare disorder, which was first described by Steinberg et al (1) in 1954. Since then, more than 200 cases have been reported (2). A considerable number of patients with isolated ACTH deficiency have been shown to possess autoantibodies to pituitary cells (2,3), and the disease is thought to be induced by an autoimmune mechanism (4). Thyroid dysfunction, encountered frequently in patients with this disorder, has been attributed to

Case Report

A 23-year-old woman was admitted to our hospital in August 1998 because of weight loss of 8 kg during the preceding 8 months, anorexia, and depression. On examination, her weight was 57 kg and height was 177 cm. The blood pressure was 100/70 mm Hg while she was sitting and 90/60 mm Hg when she was standing. Her thyroid gland was slightly enlarged. Other physical findings were completely normal. The patient reported regular menstrual cycles (30 days). She had a 1-year-old child who had been

DISCUSSION

Most cases of acquired isolated ACTH deficiency are idiopathic, and localization of the lesion is usually not possible. Isolated ACTH deficiency in our patient was confirmed by the finding of a low-normal ACTH level in conjunction with a low plasma cortisol level, lack of responsiveness to exogenous administration of CRH, subnormal cortisol response to the short ACTH stimulation test, and normal gonadotroph and somatotroph function (11). Investigators have reported that the combination of

CONCLUSION

In summary, we describe a patient with isolated ACTH deficiency associated with thyroid autoimmunity, subclinical hypothyroidism, and transient hyperprolactinemia. The correction of the related glucocorticoid deficiency resulted in resolution of the hyperprolactinemia and a decrease in titers of thyroid autoantibodies.

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