Endocrine Abstracts

Introduction: ACTH deficiency is a rare disease with non-specific symptoms such as anorexia, fatigue and weight loss. Due to these silent symptoms the disease is easily overlooked and may escape detection for a long time, especially in elderly patient.

Case: 67-year-old female patient applied with complaints of fatigue. Bilateral adrenal adenoma was detected during ultrasonographic evaluation and and patient was consulted to endocrinology clinic Her personal history included osteoporosis and multinodular goiter. On clinical examination; height 153 cm, weight: 67 kg, BMI:29 BP: 120/70 mm/Hg. The other physical examination findings were normal. Radiologic findings included: Abdominal MRI: in the right adrenal gland, 20×12 mm and 33×13 mm in left adrenal gland adenomas was detected. The laboratory findings were shown in Table 1. Basal Cortisol levels were detected as 6.6 μg/dl and insulin tolerans test and ACTH stimulation test were performed. (Table 2, Table 3).

Conclusion: Acth deficiency is rare in elderly patients is a complex disease and many diseases that mimic. Sometimes patients are diagnosed by chance. When this case was examined for adrenal adenoma, ACTH deficiency was unexpectedly detected and replacement therapy was started. The clinic has the patient improved rapidly with replacement therapy.