ackground : Combined ATCH and GH deficiency is a rare disease. Clinical and laboratory
features are variable, non-specific and similar to those seen in adrenocortical insufficiency
of any cause.
Methods : We have experienced a case of combined ACTH and GH deficiency without
combined disease. The patient, 55 years old female, was admitted because of fatigue, nausea
and vomiting on admission.
Results : Serum sodium was 112 mmol/L, potassium 3.8 mmol/L, serum osmolarity 237
m0sm/Kg and urine osmolarity 531 m0sm/Kg. Basal serum cortisol was 0.68 ug/ml, ACTH
12.7pg/ml, GH below 0.1 ng/ml, basal urinary 17-hydroxycorticosteroid(17-OHCS) 0.5 ug/dl
and blood glucose was 86 mg/dl. Although cortisol did not respond to rapid ACTH
stimulation test, it reponded to standard AVTH stimulation test. On combinded stimulation
test, the cortisol did not respond and all anterior ituitary hormone showed normal
responses except ACTH and GH. In addition, plasma cortisol and ACTH repond to
vasopressin test. There was no abnormalities in sellar CT, and hyponatremia was corrected
dramatically with prednisolone replacement.
Conclusion : Combined ACTH and GH deficiency is rare cause of secondary adrenocortical
insufficiency.It's clinical manifestation similar to isolated ACTH deficiency in adult. Patients
with isolated ACTH deficiency due to suprapituitary dysfunction may be distinguished from
those with intrinsic pituitary disease by stimulation of cortisol and ACTH secretion following
vasopressin administration. More study needed to identify the defintive cause and
hypothalamic-pituitary system.
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