Isolated acquired ACTH deficiency and primary hypothyroidism: a short series and review

Abstract

Idiopathic isolated ACTH deficiency, congenital or acquired, is rare. It may be found in association with primary hypothyroidism. Here we describe four cases of acquired idiopathic isolated ACTH deficiency illustrating its importance and variable presentation. All cases had a structurally normal pituitary gland and persistently normal residual pituitary function. Three cases had co-existing primary hypothyroidism. We discuss the protean presentation of this rare but important condition, its treatment, associations, and possible aetiologies.

Effect of acute heat stress on adrenocorticotropic hormone, cortisol, interleukin-2, interleukin-12 and apoptosis gene expression in rats

“…Among them, the main feature of the stress reaction is the activation of the HPA axis leading to the increase of ACTH and Cor (14). ACTH is one of the important pituitary hormones, mainly produced in the pituitary.…”

Thyrotoxicosis and Adrenocortical Hormone Deficiency During Immune-checkpoint Inhibitor Treatment for Malignant Melanoma

“…Higher expression of CTLA-4 in the pituitary gland was reported to be related to severe hypophysitis, based on type II or type IV allergy by anti-CTLA-4 antibodies (11). More important clinical entity is isolated ACTH deficiency (IAD), one of the fatal endocrine diseases characterized as pituitary ACTH insufficiency, possible autoimmune mechanism is involved accompanying other autoimmune diseases (12). In fact, thyroiditis and positivity of TgAb were observed in our case.…”

Isolated Adrenocorticotropic Hormone Deficiency Associated With Hashimoto's Disease and Thyroid Crisis Triggered by Head Trauma -Case Report-

“…1) IAD is frequently associated with various thyroid diseases, such as Hashimoto's thyroiditis, primary hypothyroidism, hyperthyroidism, and Graves' disease. 6,10,12,19) However, why thyroid disease should occur in association with IAD is unknown. 6) IAD has a variable clinical presentation, so is often difficult to diagnose.…”

“…6,10,12,19) However, why thyroid disease should occur in association with IAD is unknown. 6) IAD has a variable clinical presentation, so is often difficult to diagnose. However, prompt diagnosis and treatment with steroid replacement leads to resolution of all symptoms.…”

“…MR imaging is a necessary part of the diagnostic workup for IAD. Idiopathic IAD has normal pituitary structure, 6) but secondary IAD after lymphocytic hypophysitis often shows empty sella. 9) Treatment requires replacement doses of glucocorticoids.…”