Thyroid Dysfunction in isolated Adrenocorticotropic Hormone (ACTH) Deficiency: Case Report and Literature Review.

Abstract

Abstract. A case of isolated ACTH deficiency accompanying transient primary hypothyroidism was reported along with a review of literature on isolated ACTH deficiency in Japan with special reference to its association with thyroid function. Our case, a 56-year-old woman, developed somnolence and hypoglycemia due to isolated ACTH deficiency. She also had the features of hypothyroidism, namely mounding phenomenon, muscle rigidity, increased plasma myogenic enzymes and cold intolerance. Both free T3 and free T4 were decreased, and basal as well as TRH-stimulated TSH levels were abnormally high. Plasma thyroglobulin was increased and no anti-thyroid antibodies were detected. All thyroid related physical and biochemical abnormalities disappeared after hydrocortisone replacement. A review of the literature on 103 cases disclosed that more than half the cases with isolated ACTH deficiency had a high plasma level of TSH, basal and/or TRH-induced, while the antithyroid antibodies were reported to be positive in only 13 cases. In more than 70% of such cases, the abnormality in the pituitary-thyroid axis was transient and was reversed by glucocorticoid replacement. Our case and cases in the literature indicate that the interference of thyroid hormone synthesis and/or secretion by glucocorticoid deficiency per se is the major cause of thyroid dysfunction rather than associated autoimmune thyroid disease.

Hypercalcemia Accompanied by Hypothalamic Hypopituitarism, Central Diabetes Inspidus and Hyperthyroidism.

“…Autoimmune thyroiditis is fairly commonin Japanese, and about 10-20% of the female population and about 5%of the male are positive for the anti-microsomal and anti-thyroglobulin antibody (19). Solely 3% of the patients with ACTHdeficiency represent hyperthyroidism, as we have shownpreviously (18). These results may not support the concept that the prevalence of autoimmunethyroid disease is significantly higher in patients with secondary and tertiary hypocortisolism than in the Japanese general population.…”

“…This would also be the case for the results of the LH-RHtest. As we have shown previously, glucocorticoid affects the TSH-thyroid axis, which is more easily seen in patients with intrinsic thyroid disease (18). Physiological concentrations of glucocorticoid mayhave a suppressive effect on the manifestation of autoimmune thyroid disease.…”

Isolated Adrenocorticotropin Deficiency Associated with Painless Thyroiditis: A Case Report and Review of the Literature

“…The present patient also had Hashimoto's thyroiditis, as indicated by the diffuse goiter and positive tests for anti-thyroid antibodies. Both Murakami et al [10] and Hashimoto [6] have reported literature reviews about IAD associated with thyroid disorders in Japan. According to Murakami et al's review of 103 cases, 13 cases (12.6%) were positive for anti-thyroid antibodies.…”

Three Patients with Isolated Adrenocorticotropin Deficiency Presenting with Neuroleptic Malignant Syndrome-like Symptoms.

“…In patient 1, the pituitary tumor has not been examined histologically and has not changed in size so far, so it is necessary to follow up the tumor clinically and radiologically to establish the exact diagnosis. Isolated ACTHdeficiency is sometimes accompanied by various neuromusculardisturbances such as muscleatrophy (10), weakness (10), myalgia (ll, 12), cramps (ll, 12), contracture (10, 12, 13), rigidity (14,15), and peripheral neuropathy (12,15), but little attention has been paid to NMS-like symptoms. In the literature, there are 3 patients with isolated ACTH deficiency whopresented with NMS-like symptoms.…”