Isolated adrenocorticotropin deficiency presenting with impaired renin-angiotensin-aldosterone system and suppressed parathyroid hormone-vitamin D axis.
We report here a 47-year-old woman with isolated adrenocorticotropin (ACTH) deficiency (IAD). She presented impaired renin-angiotensin-aldosterone (R-A-A) system and suppressed parathyroid hormone (PTH)-vitamin D system. She showed severe hyponatremia due to secondary adrenocortical insufficiency, which was deteriorated by hypoaldosteronism. She also showed hyperphosphatemia and relative hypercalcemia with suppressed PTH-vitamin D axis. Moreover, she showed hypothyroidism, which was thought to be important to maintain normal Ca levels under secondary hypoadrenalism via decrease in bone resorption by T3. Replacement with glucocorticoid completely normalized PTH-vitamin D axis and R-A-A system. Thus, the present case implicates that severe adrenocortical deficiency due to IAD might affect both R-A-A system and PTH-vitamin D axis. These findings suggest that the ACTH-cortisol axis has an important role in mineral metabolism in vivo.
Department of Internal Medicine, Jikei University School of Medicine, Tokyo.
Takatoshi
T
Saito
Katsuyoshi
K
Tojo
Hiroyasu
H
Yamamoto
Tatsuo
T
Hosoya
Naoko
N
Tajima
D000324:Adrenocorticotropic Hormone / Q000172:deficiency* / Q000502:physiology; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002118:Calcium / Q000378:metabolism; D003940:Diagnostic Techniques, Endocrine; D004700:Endocrine System Diseases / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D006994:Hypoaldosteronism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D007011:Hypoparathyroidism / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D007018:Hypopituitarism / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D007037:Hypothyroidism / Q000150:complications / Q000503:physiopathology; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology*; D012964:Sodium / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*
D000893:Anti-Inflammatory Agents; D000324:Adrenocorticotropic Hormone; D012964:Sodium; D002118:Calcium; D006854:Hydrocortisone