Isolated ACTH deficiency associated with Hashimoto

Emine Binnetoglu; Mehmet Ask; Hacer Sen; Fahri Gunes; Erdem Akbal; Zeliha Tekeli; Betul Kizildag; Kubilay Ukinc

doi:10.1530/endoabs.32.P263

P263

Prev Next

Section Contents Cite

Endocrine Abstracts (2013) 32 P263 | DOI: 10.1530/endoabs.32.P263

ECE2013 Poster Presentations Clinical case reports – Pituitary/Adrenal (57 abstracts)

Isolated ACTH deficiency associated with Hashimoto’s disease

Emine Binnetoğlu ¹ , Mehmet Aşık ¹ , Hacer Şen ¹ , Fahri Güneş ¹ , Erdem Akbal ¹ , Zeliha Tekeli ¹ , Betül Kızıldağ ² & Kubilay Ukinç ¹

Views

Author affiliations View ePoster Download ePoster

¹Deparment of Internal Medicine, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey; ²Department of Radiology, Medical Faculty, Çanakkale Onsekiz Mart University, Çanakkale, Turkey.

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 Hashimoto’s 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 Hashimoto’s 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 (1.71–3.71), free T₄ of 0.47 ng/ml (0.7–1.48) and high TSH of 19.2 μIU/ml (0.35–1.94). The autoimmune antibodies were positive and the patient’s 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: 80–560). 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 Hashimoto’s thyroiditis that may present with severe gastrointestinal symptoms such excessive vomitting.