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

Abstract

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

Idiopathic Isolated Adrenocorticotropic Hormone Deficiency: A Single-Center Retrospective Study

“… Chronic alcohol intoxication can cause ultra-microscopic pathological changes in the endocrine cells 16 17 18 . …”

“…Our center has one patient with type 2 diabetes, three hypertensive patients, one cerebral hemorrhage pa- tient five cerebral infarction patients. Furthermore, studies have reported that a history of chronic alcoholism may be associated with the development of IIAD [16,17]. Chronic alcohol intoxication can cause ultra-microscopic pathological changes in the endocrine cells of the rat adenohypophysis, resulting in pituitary damage [18].…”