Type 1 Diabetes Mellitus and Isolated Adrenocorticotropin Deficiency Manifested by Parkinsonism: A Case Report and Literature Review

Abstract

A 67-year-old woman developed isolated adrenocorticotropin deficiency (IAD), which manifested as lethargy, a 20-kg body weight loss, hypoglycemia, and parkinsonism, and began corticosteroid replacement. Her symptoms resolved rapidly, and her weight returned to normal within six months. However, she then developed slowly progressive type 1 diabetes mellitus (T1D) with co-existing Hashimoto thyroiditis, and commenced insulin therapy. To our knowledge, this is the first reported case of parkinsonism associated with IAD. In addition, because diabetes mellitus, including T1D, could be latent in patients with untreated IAD, careful assessment of glucose metabolism is needed after commencing corticosteroid replacement until weight regain is achieved.

Clinical features and autoimmune associations in patients presenting with Idiopathic Isolated ACTH deficiency

“…However, in this series, pituitary MRI was performed in only 27 of 176 patients, and patients with TBI were not excluded, so it is not possible to be certain whether some patients had other causes of ACTH deficiency. Other case reports have described IIAD with a wide range of autoimmune illnesses, including type 1 diabetes, Crohn's disease and Graves’ disease . However, the most commonly associated autoimmune illness in the literature is hypothyroidism, and the data from our case series are in concordance with this, with 9 of the 23 patients diagnosed with primary hypothyroidism.…”

Isolated Adrenocorticotropin Deficiency Concomitant with Graves' Disease: A Case Report and Literature Review

“…The GHRP-2 test has been shown to be a diagnostic tool for secondary AI (43,44). At the time of IAD development, our patient exhibited a delayed (and slight) ACTH release to exogenous CRH (Table 2D), and in contrast, a rather rapid ACTH re- lease was observed after GHRP-2 loading (Table 2E), neither of which triggered a significant cortisol response.…”

Fulminant type 1 diabetes associated with Isolated ACTH deficiency induced by anti-programmed cell death 1 antibody—insight into the pathogenesis of autoimmune endocrinopathy—

“…IAD is a rare autoimmune endocrinopathy [2][3][4][5][6], with reported incidence ranging from 3.8 to 7.3 per 100,000 persons over a decade-long 10-year period in Japan [7]. Regarding the association of IAD and T1D, three cases of IAD were reported in association with T1D in Japanese hospitals over the past 16 years, ranging from slowly progressive to fulminant, in a more recent paper [8].…”