Case ReportIsolated Adrenocorticotropic Hormone Deficiency, Thyroid Autoimmunity, And Transient Hyperprolactinemia
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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