title: A case of adrenal insufficiency due to acquired hypothalamic CRH deficiency.
abstract: A 40-year-old woman with adrenal insufficiency was clinically diagnosed and examined with human corticotropin releasing hormone (CRH). This patient with secondary hypo-adrenalism has shown a normal serum cortisol response to exogenous ACTH administration and has been examined with CRH, lysine-vasopressin (LVP) and insulin tolerance test (ITT), respectively. Success in secreting ACTH in response to both CRH and LVP tests, but not ITT, suggests that this disorder was possibly due to a hypothalamic CRH deficiency rather than pituitary corticotroph dysfunction. A combination of the CRH test and ITT has come to play an increasingly significant role in the diagnosis and differential diagnosis of isolated ACTH deficiency syndrome.
authors.affiliation: First Department of Internal Medicine, Nagasaki University School of Medicine, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Nishihara
authors.forename: H
authors.initials: H
authors.lastname: Kimura
authors.forename: T
authors.initials: T
authors.lastname: Ishimaru
authors.forename: T
authors.initials: T
authors.lastname: Kiriyama
authors.forename: N
authors.initials: N
authors.lastname: Yokoyama
authors.forename: S
authors.initials: S
authors.lastname: Yamashita
authors.forename: S
authors.initials: S
authors.lastname: Nagataki
mesh_terms: D000309:Adrenal Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000187:drug effects / Q000378:metabolism; D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000187:drug effects / Q000378:metabolism; D003346:Corticotropin-Releasing Hormone / Q000172:deficiency*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000652:urine; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007031:Hypothalamus / Q000503:physiopathology*; D007328:Insulin / Q000008:administration & dosage; D008236:Lypressin / Q000008:administration & dosage; D010901:Pituitary Function Tests; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D008236:Lypressin; D000324:Adrenocorticotropic Hormone; D003346:Corticotropin-Releasing Hormone; D006854:Hydrocortisone