Stress-induced cortisol release in hypothalamic hypoadrenalism.
A 52-year-old woman experienced hypoadrenalism (mean 8 AM plasma cortisol level, 3.7 microgram/dL) after hypothalamic surgery and radiotherapy for craniopharyngioma. Despite low plasma adrenocorticotropic hormone levels (less than 25 pg/mL), absent diurnal variation of the plasma cortisol level, and subnormal urinary 17-hydroxycorticosteroid response to metyrapone, she had normal plasma cortisol responses to insulin-induced hypoglycemia and to administration of vasopressin or synthetic adrenocorticotropic hormone. Stress-induced cortical release may be preserved despite notable abnormalities in regulation of cortisol secretion by diurnal and feedback-mediated mechanisms.
D015065:17-Hydroxycorticosteroids / Q000652:urine; D000309:Adrenal Insufficiency / Q000503:physiopathology*; D000324:Adrenocorticotropic Hormone / Q000378:metabolism; D002940:Circadian Rhythm; D003397:Craniopharyngioma / Q000601:surgery; D005246:Feedback; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D007031:Hypothalamus / Q000503:physiopathology* / Q000601:surgery; D008797:Metyrapone / Q000494:pharmacology; D008875:Middle Aged; D010911:Pituitary Neoplasms / Q000532:radiotherapy / Q000601:surgery; D011182:Postoperative Care; D013315:Stress, Psychological / Q000523:psychology*
D015065:17-Hydroxycorticosteroids; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D008797:Metyrapone