A case of congenital hypopituitarism: difficulty in the diagnosis of ACTH deficiency due to high serum cortisol levels from a hypothyroid state
| Autor: | Toshinori Tsukuda, Yukihiro Hasegawa, Kenji Nanao, Makoto Anzo, Junko Miyamoto |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Male
endocrine system medicine.medical_specialty Hydrocortisone Corticotropin-Releasing Hormone Endocrinology Diabetes and Metabolism Thyrotropin Hypoglycemia Hypopituitarism Gonadotropin-Releasing Hormone Basal (phylogenetics) Endocrinology Anterior pituitary Adrenocorticotropic Hormone Hypothyroidism Internal medicine medicine Humans Testosterone Cortisol level Thyrotropin-Releasing Hormone Subclinical infection Morning business.industry Human Growth Hormone Infant Congenital hypopituitarism medicine.disease Magnetic Resonance Imaging Thyroxine medicine.anatomical_structure business hormones hormone substitutes and hormone antagonists Hormone |
| Zdroj: | Endocrine journal. 46(1) |
| ISSN: | 0918-8959 |
| Popis: | A three-month-old boy presented congenital hypopituitarism in which the hypothyroid state masked ACTH deficiency. Multiple anterior pituitary hormone deficiencies, including ACTH, were finally confirmed. High basal serum cortisol levels (up to 45.1 microg/dl) were observed during a stressful episode before L-thyroxine replacement therapy was started. Decreased morning serum cortisol levels (5.0 microg/dl or below) were observed on the sixth day of L-thyroxine replacement therapy despite mild hypoglycemia (lowest serum glucose level of 50 mg/dl). ACTH deficiency was then confirmed by insulin-induced hypoglycemia test (peak serum cortisol level of 4.9 microg/dl). The present findings showed that serum cortisol levels can be high during a stressful episode in an infant with ACTH deficiency and a coexisting hypothyroid state. Thus, the diagnostic evaluation of adrenal function soon after L-thyroxine replacement therapy is important in order to verify a possible subclinical ACTH deficiency, even in the presence of high serum cortisol levels before L-thyroxine replacement therapy. |
| Databáze: | OpenAIRE |
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