Two Cases of Asymptomatic Adrenocortical Insufficiency with Autoimmune Thyroid Disease.

Abstract

Abstract.Two cases of asymptomatic adrenocortical insufficiency are reported. Both patients had a normal cortisol and increased ACTH.The cortisol response to ACTH was impaired, although not absent, in both cases. One case was associated with autoimmune polyglandular syndrome type II (Graves' disease and vitiligo), and the other was possibly associated with an early stage of Hashimoto's thyroiditis, suggesting autoimmune pathogenesis of their adrenocortical insufficiency.CT of the abdomen revealed unilateral enlargement of the adrenal glands in one case, but no enlargement of the adrenal glands in another case. Adrenal hypofunction seemed to be compensated for by increased trophic hormone (ACTH), as in subclinical hypothyroidism. However, prolonged ACTH stimulation increased urinary 17-OHCS in both cases, and normalized cortisol response to ACTH in one case. In both cases, the plasma renin activity (PRA) and plasma aldosterone concentration (PAC) were normal, and adrenal autoantibodies were negative, suggesting that neither negative adrenal autoantibodies nor normal PRA can exclude asymptomatic adrenocortical insufficiency.The results suggest that a rapid ACTH test should be performed in cases with increased ACTH, especially those associated with other autoimmune endocrine disorders.

Comorbid Latent Adrenal Insufficiency with Autoimmune Thyroid Disease

“…It has been described by a variety of terms, i.e. ‘asymptomatic' [4], ‘subclinical' [5,7], ‘preclinical' [6], ‘hidden' [8], ‘early' [19], ‘occult' [20], and ‘biochemical' [21] adrenal insufficiency. As clinical features were not thoroughly explored in the patients from these reports, clinical presentation of the present patients cannot be compared with those of these patients.…”

“…low or low-normal cortisol levels, normal ACTH levels, and a low level of aldosterone only in one patient, are not very different from the respective values of these patients at transitional stages, i.e. normal basal cortisol levels, basal ACTH levels either normal or elevated [4,5,6,7,21], and the aldosterone levels either low [18] or normal [4,7]. Hence, the disorder of the present patients is consistent with PAI at a transitional stage.…”

“…In contrast, less than 20 cases of comorbid PAI with ATD have been found in the English literature: 3 ATD patients with elevated plasma adrenocorticotropic hormone (ACTH) levels were proven to have subclinical PAI by a provocation test [4,5], and several ATD patients preliminarily screened by antiadrenal autoantibody tests were shown to have PAI by a provocation test [6,7]. PAI is usually pursued in the advanced stage (i.e.…”

Reversible adrenal insufficiency and heterophile antibodies in a case of autoimmune polyendocrinopathy syndrome

“…Two cases of asymptomatic adrenal insufficiency have been reported in patients with autoimmune thyroiditis who were negative for adrenal antibodies. [12] Surprisingly, his adrenal function recovered after achieving euthyroidism with thyroxin replacement, which to best of our knowledge, has not been reported in the literature, though, vice versa has been reported. [13] Hypothyroidism is a state of altered metabolic dysfunction which is characterized by reversible alterations of lipid profile, uric acid, blood pressure, liver and renal function.…”

Vitiligo: Auto‐immunity and immune responses

“…[10][11][12][13][14][15][16] Furthermore, autoimmune disorders are infamous in the development vitiligo. [17][18][19][20][21][22][23][24][25][26] Thyroid diseases, Hashimoto thyroiditis and Grave's disease, [27][28][29] pernicious anemia, [30][31][32][33] diabetes mellitus, 32,34 alopecia areata, 19,[36][37][38] and Addison's disease 22,39,40 are a few pre-eminent disorders prejudiced to develop vitiligo. Auto-antibodies directed against leading and other organ systems might also be present without an explicit clinical correlation.…”