Endocrine Abstracts

Pitüitary ACTH deficiency is one cause of secondary adrenal insufficiency. Genetic factors, autoimmunity, infiltrative disease, cranial trauma can cause ACTH deficiency. Hyperpigmented skin lesions are expected in primary adrenal insufficiency while they are very rare in secondary adrenal insufficiency. Striae are characterized by linear smooth bands of atrophic appearing skin. They are mostly associated with obesity, pregnancy, hypercortisolism/Cushing syndrome. Striae are not an expected finding in hypocortisolemia. A 34-year-old male patient, referred to the endocrinology clinic for the evaluation of red-purple colored striae on both armpits. The case self-reported that the skin lesions appeared ~4 months ago and spread over time, and occurred also on his abdomen. He did not have history of any chronic disease or drug therapy; but had cranial operation twice 12 years ago due to a car accident, and an arterial embolization procedure due to internal carotid artery aneurysm a year later. On his physical examination was normal. Hematologic, biochemical, and hormonal tests were measured. Plasma ACTH (1.6 pg/ml) and cortisol (0.18 μg/dl) levels were low. For evaluation of HPA axis, cosyntrophin, TRH and LH–RH tests were conducted. The patient responded to TRH (basal: 2.86 μIU/ml, max: 10.43 μIU/ml) and LH-RH (basal: 3.25 mIU/ml, max: 12.30 mIU/ml) stimulation tests. However, in the standard ACTH stimulation test, adrenal gland could have a suboptimal cortisol response (basal: 0.22 μg/dl; max 8.30 μg/dl). There were no abnormalities on the adrenal and pituitary MR images. However, secondary defects due to cranial trauma were seen in cranial MR. Based on the laboratory and MR examinations, the case was considered a posttraumatic ACTH deficiency case that developed as a result of head trauma and intracranial operations. We presented case of posttraumatic ACTH deficiency with hypocortisolemia after we investigated suspect hypercortisolemia/Cushing syndrome due to striae.