title: Improved response of growth hormone to growth hormone-releasing hormone and reversible chronic thyroiditis after hydrocortisone replacement in isolated adrenocorticotropic hormone deficiency.
abstract: We report a 44-year-old Japanese man who showed a reversible blunted response of growth hormone (GH) to GH-releasing hormone (GRH) stimulation test and reversible chronic thyroiditis accompanied by isolated ACTH deficiency. He was admitted to our hospital because of severe general malaise, hypotension, and hypoglycemia. He showed repeated attacks of hypoglycemia, and his serum sodium level gradually decreased. Finally, he was referred to the endocrinology division, where his adrenocorticotropic hormone (ACTH) and cortisol values were found to be low, and his GH level was slightly elevated. An increased value of thyroid stimulating hormone (TSH) and decreased values of free triidothyronine and free thyroxine were observed along with anti-thyroglobulin antibody, suggesting chronic thyroiditis. Pituitary stimulation tests revealed a blunted response of ACTH and cortisol to corticotropin-releasing hormone, and a blunted response of GH to GRH. Hydrocortisone replacement was then started, and this improved the patient's general condition. His hypothyroid state gradually ameliorated and his titer of anti-thyroglobulin antibody decreased to the normal range. Pituitary function was re-evaluated with GRH stimulation test under a maintenance dose of 20 mg/day hydrocortisone and showed a normal response of GH to GRH. It is suggested that re-evaluation of pituitary and thyroid function is useful for diagnosing isolated ACTH deficiency after starting a maintenance dose of hydrocortisone in order to avoid unnecessary replacement of thyroid hormone.
authors.affiliation: Department of Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Inagaki
authors.forename: Haruhiro
authors.initials: H
authors.lastname: Sato
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Miyamoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Hirukawa
authors.forename: Asako
authors.initials: A
authors.lastname: Sawaya
authors.forename: Takayo
authors.initials: T
authors.lastname: Miyakogawa
authors.forename: Ryoko
authors.initials: R
authors.lastname: Tatsumi
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kakuta
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000172:deficiency*; D000328:Adult; D002908:Chronic Disease; D013006:Growth Hormone / Q000097:blood*; D013007:Growth Hormone-Releasing Hormone / Q000008:administration & dosage; D020249:Hormone Replacement Therapy / Q000379:methods*; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D010901:Pituitary Function Tests; D013960:Thyroid Function Tests; D013963:Thyroid Hormones / Q000097:blood; D013966:Thyroiditis / Q000097:blood* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D013963:Thyroid Hormones; D000324:Adrenocorticotropic Hormone; D013006:Growth Hormone; D013007:Growth Hormone-Releasing Hormone; D006854:Hydrocortisone