A case of post-traumatic isolated ACTH deficiency with spontaneous recovery 9 months after the event

Karavitaki, Niki

doi:10.1136/jnnp.2005.070482

Cited by 14 publications

(12 citation statements)

References 6 publications

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“…Although lymphocytic hypophysitis has been recognized as one of causes of postpartum AI, this possibility is unlikely since the pituitary function and pituitary image on MRI were normal. Administration of supraphysiological doses of glucocorticoids or drugs used in intensive care, brain injury and subarachnoid hemorrhage have been reported to be possible causes for secondary AI, which may recover spontaneously [1,2]. However, our case had no history of medication of any glucocorticoid or any other drug which may cause AI, or episodes like traumatic brain injury etc.…”

Section: Discussionmentioning

confidence: 73%

Postpartum hypothalamic adrenal insufficiency with remission: A rare case

et al. 2017

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Section: Discussionmentioning

confidence: 73%

Postpartum hypothalamic adrenal insufficiency with remission: A rare case

et al. 2017

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“…In support of this hypothesis, antibodies against a 22 kDalton pituitary protein have been detected in patients with IAD or lymphocytic hypophysitis [6,7]. Post-traumatic ACTH deficiency is usually associated with other pituitary defects; persistent [8] or transient [9] post-traumatic IAD has been described. IAD may also be part of an atypical Sheehan's syndrome [10], be associated to empty sella [11] and appear after radiation therapy for brain tumor [12].…”

Section: Demographics and Pathogenesismentioning

confidence: 87%

Isolated corticotrophin deficiency

2006

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Isolated ACTH deficiency (IAD) is a rare disorder, characterized by secondary adrenal insufficiency (AI) with low or absent cortisol production, normal secretion of pituitary hormones other than ACTH and the absence of structural pituitary defects. In adults, IAD may appear after a traumatic injury or a lymphocytic hypophysitis, the latter possibly due to autoimmune etiology. Conversely, a genetic origin may come into play in neonatal or childhood IAD. Patients with IAD usually fare relatively well during unstressed periods until intervening events spark off an acute adrenal crisis presenting with non specific symptoms, such as asthenia, anorexia, unintentional weight loss and tendency towards hypoglycemia. Blood chemistry may reveal mild hypoglycemia, hyponatremia and normal-high potassium levels, mild anemia, lymphocytosis and eosinophilia. Morning serum cortisol below 3 microg/dl are virtually diagnostic for adrenal insufficiency. whereas cortisol values comprised between 5-18 microg/dl require additional investigations: insulin tolerance test (ITT) is considered the gold standard but-when contraindicated-high or low dose-ACTH stimulation test with serum cortisol determination provides a viable alternative. Plasma ACTH concentration and prolonged ACTH infusion test are useful in differential diagnosis between primary and secondary adrenal insufficiency. For some patients with mild, near-to-asymptomatic disease, glucocorticoid replacement therapy may not be required except during stressful events; for symptomatic patients, replacement doses i.e., mean daily dose 20 mg (0.30 mg/kg) hydrocortisone or 25 mg (0.35 mg/kg) cortisone acetate, are usually sufficient. Administration of mineralocorticoids is generally not necessary as their production is maintained.

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“…Transient dysfunction recovering within the first year has been reported 2,20 . Our cohort was tested 1 year post‐traumatically, with confirmatory tests performed within 1 to 3 months.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and predictive factors of post‐traumatic hypopituitarism

Klose¹,

Juul

Poulsgaard

et al. 2007

Clinical Endocrinology

149

117

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The prevalence of hypopituitarism was estimated at 16%. Although high, this value was lower than previously reported, and may still be overestimated because of well-known confounding factors, such as obesity. Indicators of increased TBI severity were predictive of hypopituitarism, with a high negative predictive value. Neuroendocrine evaluation should therefore be considered in patients with severe TBI, and in particular in those with increased intracerebral pressure (ICP).

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A case of post-traumatic isolated ACTH deficiency with spontaneous recovery 9 months after the event

Cited by 14 publications

References 6 publications

Postpartum hypothalamic adrenal insufficiency with remission: A rare case

Postpartum hypothalamic adrenal insufficiency with remission: A rare case

Isolated corticotrophin deficiency

Prevalence and predictive factors of post‐traumatic hypopituitarism

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