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).
|Cases||Age||Sex||Autoimmune thyroid disease||Years of control||MRI pituitary||Clinical features|
|1||33||F||yes||1||pituitary gland normal||Syncope, hypoglycemia amenorrheoa|
|2||40||F||yes||5||pituitary gland normal||General fatigue, headache, amenorrheoa|
|3||40||M||no||15||pituitary gland normal||Polyserositis, decreased libido and potency|
|4||28||F||no||11||symmetric enlargement||General fatigue, amenorrheoa, headache|
|5||37||F||no||19||symmetric enlargement||Headache, amenorrheoa|
|Cases||FT4 ng/dl||TSH μ/ml||PRL ng/ml||GH ng/ml||IgF-1 nmol/l||ACTH pg/ml||Cortisol nmol/l||LH μ/ml||FSH mU/ml||E pg/ml||T ng/ml|
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.
03 - 07 May 2008
European Society of Endocrinology