Isolated Adrenocorticotropic Hormone Deficiency Associated with Growth Hormone Deficiency and Empty Sella.

Abstract

A 38-year-old man had an acute onset of consciousness loss, pyrexia and hyponatremia. Plasma Adrenocorticotropic Hormone (ACTH)and cortisol levels were low. Plasma ACTHfailed to respond to corticotropin-releasing hormone (CRH)and insulin-induced hypoglycemia whereas i.m. injection of ACTH-Zraised plasma cortisol. Plasma insulin-like growth factor-I (IGF-I) and urine growth hormone (GH) concentrations were also low and plasma thyroid-stimulating hormone(TSH) level was rather elevated. Plasma IGF-I and TSHlevels were not completely normalized by glucocorticoid (GC) replacement alone although plasma GHresponses to pharmacological stimuli were normalized. The GCreplacement in combination with daily s.c. injection of recombinant human GH(rhGH) not only normalized plasma IGF-I and IGFBP-3 levels, but also further lowered the plasma TSHlevel, possibly due to an increased T4/T3 conversion, which resulted in a beneficial change in body composition. (Internal Medicine 34: 688-691, 1995)

Short Term Treatment with Different Doses of Human Growth Hormone in Adult Patients with Growth Hormone Deficiency.

“…There was a positive correlation between serum IGF-I and IGF-BP3. These findings support previous reports indicating that synthesis of IGFBP-3 depends on GH secretion [10,13], indicating that serum IG-FBP-3 as well as serum IGF-I is a good indicator of early response to GH treatment in adult GHD.…”

“…Serum insulin-like growth factor I (IGF-I) was measured by specific RIA after acid ethanol extraction as reported previously [12]. Serum IGF-binding protein 3 (IGFBP-3) was measured by immunoradiometric assay (IRMA) with a commercial kit (Diagnostic Systems Lab., Webster, U.S.A.) [13]. Biochemical parameters including serum total cholesterol, non-esterified fatty acids (NEFA), triglyceride, alkaline phosphatase, urea …”

Adrenal Insufficiency

“…2 The low serum insulin-like growth factor 1 in a patient with hypopituitarism strongly suggests growth hormone deficiency. 3 The etiology, diagnosis, and therapy of primary and secondary AI, as well as the differences between these 2 disease states, are reviewed herein.…”