Isolated Corticotrophin-deficiency Found through Alcohol-induced Hypoglycemic Coma

Baba, Shigeaki; Takase, Shujiro; Uenoyama, Rinzo; Morita, Satoshi; Mizoi, Y; Hishida, Shigeru

doi:10.1055/s-0028-1093634

Cited by 9 publications

(3 citation statements)

References 4 publications

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“…Severe hyponatremia without hyperkalaemia was found in all 3 of them, one had hypoglycaemia, and in 2 anemia was noted [14]. In other case reports [13,15], severe hypoglycaemia was the main abnormality in the affected persons. It should be emphasized that all the aforesaid symptoms are common in alcoholics, which additionally impedes diagnostics.…”

Section: Reviewmentioning

confidence: 77%

“…The other causes of IAD include pituitary trauma [2], primary empty saddle [11], and cases of possible "exhaustion" of central CRH/ACTH resources, resulting in secondary adrenal insufficiency [12]. Several cases of IAD related to chronic alcoholism were also described [13][14][15]. In some cases, the aetiology remains unknown.…”

Section: Aetiology Of Iadmentioning

confidence: 99%

“…The mechanism of such suppression is not clear, but a growing body of evidence indicates that alcohol abuse produces persistent dysregulation of several neurotransmitters and neuropeptides, including increased activity of gamma-aminobutyric acid (GABA), endogenous opiate (EOP), and atrial natriuretic peptide (ANP), which can inhibit the HPA axis [19]. In view of the medical literature, alcoholism may be a rare cause of IAD [13][14][15]. Kearney et al [14] reported the history of 3 patients who chronically abused alcohol, diagnosed with IAD.…”

Section: Reviewmentioning

confidence: 99%

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Rare clinical problem — isolated ACTH deficiency associated with chronic alcohol abuse

et al. 2022

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IAD seems to be a rare cause of hyponatremia. In one of the larger clinical studies, in a group of 185 patients with severe hyponatremia (< 130 mmol/L) only 28 had secondary adrenal insufficiency, but most of them had also deficiencies of other pituitary hormones [4]. The mechanism of hyponatremia in IAD includes a reduced glomerular filtration rate and ineffective inhibition of vasopressin secretion caused by hypocortisolaemia [2, 5]. Because IAD is not associated with deficiency of aldosterone, the mechanism of salt-wasting is less important [2]. Diagnosis of IADDiagnostic procedures for IAD should start from assessment of morning cortisol concentrations. Results lower than 3.0 µg/dL, accompanied by low ACTH level, are indicative for IAD [2]. When cortisol is in the range 3.0-10.0 µg/dL, dynamic stimulatory tests [with insulin, glucagon, corticotropin-releasing hormone (CRH), or tetracosactide] are recommended [2,3]. It should be stressed that there is also no cortisol response to Synacthen in the secondary adrenal insufficiency if the standard (not extended) test duration is used. In Poland

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Section: Reviewmentioning

confidence: 77%

Section: Aetiology Of Iadmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

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Rare clinical problem — isolated ACTH deficiency associated with chronic alcohol abuse

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Isolated Corticotropin Deficiency in Adults

Yamamoto

Fukuyama²,

Hasegawa³

et al. 1992

Arch Intern Med

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The clinical and laboratory findings in 76 patients with isolated corticotropin deficiency (10 of our own and 66 from literature) were analyzed with the following observations. With the exceptions of hyperpigmentation and hyperkalemia, the similarity of symptoms and signs to those of Addison's disease and their reversibility by glucocorticoids indicate that most, but not all, manifestation of isolated corticotropin deficiency is caused by glucocorticoid deficiency. Isolated corticotropin deficiency seems to be of pituitary origin in most patients, as shown by lack of corticotropin response to insulin-induced hypoglycemia, vasopressin, or corticotropin-releasing factor. Secretion of other pituitary hormones is frequently abnormal, which is mostly attributable to glucocorticoid deficiency. Although the pathogenesis of isolated corticotropin deficiency is unknown in most patients, association with other autoimmune endocrinopathies, postpartum onset in women, or serum antipituitary antibodies suggests an autoimmune pathogenesis in some patients. In two of our 10 patients, cancer developed during glucocorticoid treatment. More observations of complications and long-term prognosis following glucocorticoid therapy are needed for optimal clinical decision making.

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Anterior Pituitary

Daughaday¹

1978

The Year in Endocrinology 1977

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Isolated Corticotrophin-deficiency Found through Alcohol-induced Hypoglycemic Coma

Cited by 9 publications

References 4 publications

Rare clinical problem — isolated ACTH deficiency associated with chronic alcohol abuse

Rare clinical problem — isolated ACTH deficiency associated with chronic alcohol abuse

Isolated Corticotropin Deficiency in Adults

Anterior Pituitary

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