Introduction: Isolated ACTH deficiency (IAD) is a rare disease which is characterized by secondary adrenal insufficiency with low cortisol production and normal secretion of pituitary hormones except ACTH. Isolated ACTH deficiency has rare association with Hashimotos disease which is characterized by autoimmune origin. This suggests the possibility of common autoimmune process affecting both the pituitary and the thyroid gland. We report a case of IAD with Hashimotos disease in a patient who presented with anorexia, nausea, vomiting and weight loss.
Case report: A 84 year-old man presented with anorexia, nausea, vomiting and weight loss for the last 3 months. His endoscopy revealed a Mallory-Weiss tear in esophagus. Sclerotherapy was performed. The laboratory test established hypothyroidism with plasma levels of free T3 of 1.89 pg/ml (1.713.71), free T4 of 0.47 ng/ml (0.71.48) and high TSH of 19.2 μIU/ml (0.351.94). The autoimmune antibodies were positive and the patients level of cortisol was found 1.22 μg/dl. ACTH levels were determined as 3.4 pg/ml. The patient was diagnosed with secondary adrenocortical insufficiency. We examined the other pituitary hormones such as FSH, LH, prolactin and GH which were in normal limits. DHEA-S level was found 18.7 μg/dl (E: 80560). The magnetic resonance of pituitary imaging was normal. Hyrocortisone and L-thyroxine supplemention improved his symptoms.
Conclusion: Isolated ACTH deficiency is a rare cause of adrenal insufficiency which can be associated with Hashimotos thyroiditis that may present with severe gastrointestinal symptoms such excessive vomitting.
27 Apr - 01 May 2013
European Society of Endocrinology