Long-lasting subclinical Addison's disease.
OBJECTIVE
To report a patient with autoimmune adrenal disease and increased ACTH with longstanding hyperpigmentation as an isolated symptom.


METHODS
A 49-year-old woman requested a diagnostic work-up for hyperpigmentation initiated 9 years before, associated with increased ACTH. She was receiving replacement therapy for autoimmune hypothyroidism. Basal and dynamic tests of glucocorticoid axis, basal investigation of mineralocorticoid axis and measurement of organ specific autoantibodies were performed.


RESULTS
Plasma ACTH (143 pmol/l; normal <13.2 pmol/l) and antibodies against 21-hydroxylase (115 UI/ml; normal <1) were remarkably high, thyroid peroxidase and parietal cell antibodies were positive at low titer and all additional tests were normal.


CONCLUSIONS
Autoimmune adrenal disease can have a very long preclinical period even with high concomitant ACTH and specific antibody titers.
Torrejón
S
S
Department of Endocrinology and Nutrition, Hospital Santa Creu i Sant Pau, Autonomous University of Barcelona, 08025 Barcelona, Spain. storrejon@gmail.com
Webb
S M
SM
Rodríguez-Espinosa
J
J
Martínez de Osaba
M J
MJ
Corcoy
R
R
D000224:Addison Disease / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000450:Aldosterone / Q000097:blood; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D017495:Hyperpigmentation / Q000209:etiology; D008875:Middle Aged; D013972:Thyrotropin / Q000097:blood
D000450:Aldosterone; D000324:Adrenocorticotropic Hormone; D013972:Thyrotropin; D006854:Hydrocortisone