Cortisol insufficiency caused by electroconvulsive therapy? A case report.
A 30-year-old woman was treated with a series of electroconvulsive therapy (ECT) due to a personality disorder with depressive symptoms. Three days after the last ECT, anisocoria was noticed. It subsided after 2 days, and attacks of syncope, vertigo, anorexia and weight loss started. These symptoms ceased by administration of cortisone acetate and fluoro-cortisone. During an observation time of five years, repeated attempts to omit the cortico-steroids or reduce the cortisone dose to less than 20 mg/day have resulted in immediate symptoms of cortisol deficiency. Plasma adrenocorticotrophin (ACTH) and cortisol and urinary cortisol were low during cortisol withdrawal. Cortisol response to ACTH stimulation and cortisol and ACTH response to hypoglycemia were normal. The cortisol deficiency was considered to be due to a defect in the central nervous regulation of ACTH secretion. As it occurred in close connection to ECT, it seems likely that the treatment induced a defect, or aggravated a preexisting one, in neural pathways controlling corticotrophin-releasing factor and ACTH secretion.
D000324:Adrenocorticotropic Hormone / Q000378:metabolism / Q000494:pharmacology; D000328:Adult; D004565:Electroconvulsive Therapy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000172:deficiency*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D010913:Pituitary-Adrenal System / Q000503:physiopathology
D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone