ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2008) 16 P414

Autoimmune hypophysitis and isolated corticotrophin deficiency

Alfonso Gentil, Tomás Martin, Alberto Torres, Isabel Serrano, Cristobal Morales, Silvia Maraver, Guiillermo Martinez de Pinillos, Juan Manuel Garcia-Quiros & Angel Sendon


Virgen Macarena Hospital, Seville, Spain.


Introduction: Isolated ACTH failure is a rare disorder characterized by a secondary adrenal failure and a considerable deterioration of the general state. In adults the has been established related to cranial traumatism and to autoimmune hypophysitis (AH). It has been pointed out that the isolated failure of pituitary tropin in the context of a AH, could end with a global pituitary failure.

Objective: Evaluation of the shortage of isolated ACTH as a way of presentation of the AH.

Materials and method: There will be described two cases of selective failure of ACTH (cases 1 and 2), with an acute beginning of the symptoms, and its development along time. They will be compared with three cases of HA with combined hormone secretion alterations (cases 3, 4 and 5) with a more silent course.

The nomination of the pituitary antibodies was carried out by indirect immunofluorescence technique, using human pituitary (cases 3 and 4) or primates ones (cases 1, 2 and 5).

Results:

CasesAgeSexAutoimmune thyroid diseaseYears of controlMRI pituitaryClinical features
133Fyes1pituitary gland normalSyncope, hypoglycemia amenorrheoa
240Fyes5pituitary gland normalGeneral fatigue, headache, amenorrheoa
340Mno15pituitary gland normalPolyserositis, decreased libido and potency
428Fno11symmetric enlargementGeneral fatigue, amenorrheoa, headache
537Fno19symmetric enlargementHeadache, amenorrheoa
CasesFT4 ng/dlTSH μ/mlPRL ng/mlGH ng/mlIgF-1 nmol/lACTH pg/mlCortisol nmol/lLH μ/mlFSH mU/mlE pg/mlT ng/ml
10.948.812.51.55413.6468923
20.971240.272727139.7
30.484.13.71.44.2011200.741.434
40.850.620541.3134870.200.570.20
50.621.87411.131015.73330.22.40.54

Conclusion: The isolated failure of ACTH is able be the way of presentation of an autoimmune hypophysitis, although the disease could or could not turn into a panhypopituitarism. In this case this may be its debut clinic manifestation.

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