Isolated ACTH Deficiency

Luis, Daniel Antonio de; Aller, R.; Romero, Eduardo

doi:10.1159/000023179

Cited by 23 publications

(11 citation statements)

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“…Symptoms and signs of adrenal insufficiency are nonspecific, such as general malaise, decreased mental function, gastrointestinal symptoms, hypotension, and hypoglycemia; therefore, isolated ACTH deficiency often goes undiagnosed. In the absence of a correct diagnosis and supplementation therapy, powerful stressors such as external wounds, infections, surgery, or bleeding can trigger acute adrenal insufficiency, and the disease may become lethal [1]. In our case, we observed no preoperative symptoms or signs of adrenal insufficiency; however, early symptoms of general malaise and easy fatigability may have been masked by cardiac failure symptoms associated with mitral insufficiency.…”

Section: Discussionmentioning

confidence: 47%

“…Under normal conditions, this disease shows nonspecific symptoms, including general malaise, decreased mental function, gastrointestinal symptoms, hypotension, and hypoglycemia; therefore, cases commonly go undiagnosed. However, under stressful conditions, a patient's life may suddenly be at risk because of the inability to secrete ACTH in response to the stressor [1]. Here we report a cardiotomy under extracorporeal circulation in a patient who suffered complications from isolated ACTH deficiency.…”

Section: Introductionmentioning

confidence: 92%

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Catecholamine-resistant shock and hypoglycemic coma after cardiotomy in a patient with unexpected isolated ACTH deficiency

et al. 2011

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Isolated adrenocorticotropic hormone (ACTH) deficiency is an extremely rare disease in which ACTH-producing cells of the pituitary gland are selectively damaged. The resulting decline in ACTH production and secretion results in chronic secondary adrenocortical insufficiency. The patient in this case did not present with adrenal insufficiency symptoms prior to surgery. However, after cardiotomy under extracorporeal circulation, the patient lapsed into a catecholamine-resistant shock and hypoglycemic coma. Acute adrenal insufficiency was strongly suspected, and the patient was diagnosed with isolated ACTH deficiency after careful examination. Because the demand for cortisol increases after highly invasive surgeries, cortisol supplementation therapy is essential for patients with complications from isolated ACTH deficiency. There is a high risk of a lethal outcome when surgery is carried out without a diagnosis, as in this case. Therefore, cortisol must be supplemented without delay when acute adrenal insufficiency is suspected during the perioperative period.

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Section: Discussionmentioning

confidence: 47%

Section: Introductionmentioning

confidence: 92%

Catecholamine-resistant shock and hypoglycemic coma after cardiotomy in a patient with unexpected isolated ACTH deficiency

et al. 2011

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“…However, it has been reported that powerful stressors such as external wounds, infections, surgery, or bleeding can trigger acute adrenal insufficiency [11]. Although it is difficult to clarify whether the gastric cancer metastasis or chemotherapy triggered the onset of IAD in our case, we speculate that the stress of febrile neutropenia, which was a severe adverse effect of chemotherapy, might have triggered the onset of IAD because the patient had undergone gastric cancer treatment without IAD symptoms for more than 2 years.…”

Section: Discussionmentioning

confidence: 99%

Isolated adrenocorticotropic hormone deficiency development during chemotherapy for gastric cancer: a case report

et al. 2014

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IntroductionIsolated adrenocorticotropic hormone deficiency is an endocrinological disorder characterized by loss of adrenocorticotropic hormone and resultant adrenal insufficiency. Affected patients often present with fatigue, anorexia, and hyponatremia. Although the number of reported cases has been recently increasing, isolated adrenocorticotropic hormone deficiency combined with malignant neoplasia is very rare. Here we describe a patient with gastric cancer who developed unexpected isolated adrenocorticotropic hormone deficiency during chemotherapy.Case presentationA 72-year-old Japanese man was admitted to our hospital because of febrile neutropenia due to chemotherapy for gastric cancer recurrence. Although the neutropenia and fever immediately improved, he became unable to take any oral medications and was bedridden 1 week after admission. His serum sodium level abruptly decreased to 122mEq/L on the fifth day of hospitalization. We performed endocrinological studies to investigate the cause of his hyponatremia and plasma hyposmolality. His plasma adrenocorticotropic hormone and cortisol levels were very low. However, his serum levels of all other anterior pituitary hormones were slightly elevated. We then performed a corticotropin-releasing hormone test, which showed that neither his plasma adrenocorticotropic hormone nor cortisol level responded to corticotropin-releasing hormone stimulation. We definitively diagnosed isolated adrenocorticotropic hormone deficiency based on these findings. Hydrocortisone replacement therapy was begun at 20mg/day, resulting in a marked improvement in his anorexia and general fatigue within a few days. His serum sodium level was also normalized immediately after the administration of hydrocortisone. He was discharged from our hospital on the 50th day of hospitalization.ConclusionsThe present case is the second report of a patient with concurrent isolated adrenocorticotropic hormone deficiency and gastric cancer and the first report of a patient diagnosed with isolated adrenocorticotropic hormone deficiency during the course of chemotherapy for a solid malignant neoplasm. Although the symptoms and signs described in the present report are common observations during chemotherapy, it is important to consider not only the adverse effects of antineoplastic agents, but also isolated adrenocorticotropic hormone deficiency as a differential diagnosis. Hydrocortisone replacement therapy for isolated adrenocorticotropic hormone deficiency effectively avoids the unnecessary cessation of chemotherapy.

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“…The prevalence of diagnosed cases is 1.91/1 000 000 in the Miyazaki prefecture, 7.3/1 000 000 in Tokushima area and 3.8/1 000 000 in Chuetsu district in Japan 5 6. There seems to be a substantial number of undiagnosed patients because clinical diagnosis is made when the patient becomes severely ill due to physical stress 7 8. Although nausea and vomiting are the most common symptoms of adrenal insufficiency, seen in more than 90% of patients,9 10 IAD patients who present with oesophageal ulcers are very rare 11–13.…”

Section: Discussionmentioning

confidence: 99%

A patient with isolated adrenocorticotropin deficiency presenting with repetitive oesophageal ulcer and stenosis

Tamiya

Ishikawa²,

Mano³

et al. 2010

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Isolated ACTH Deficiency

Cited by 23 publications

References 11 publications

Catecholamine-resistant shock and hypoglycemic coma after cardiotomy in a patient with unexpected isolated ACTH deficiency

Catecholamine-resistant shock and hypoglycemic coma after cardiotomy in a patient with unexpected isolated ACTH deficiency

Isolated adrenocorticotropic hormone deficiency development during chemotherapy for gastric cancer: a case report

A patient with isolated adrenocorticotropin deficiency presenting with repetitive oesophageal ulcer and stenosis

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