Isolated ACTH deficiency with transitory GH deficiency

Abstract

A nine-year-old girl, who presented with a severe hypoglycemic coma, proved to have isolated ACTH deficiency, a finding previously reported in only two children. On the initial evaluation, before any treatment, GH did not respond to provocative stimuli. On replacement therapy with hydrocortisone, normal linear growth was observed. Repeated testing while on glucocorticoids replacement four years after the initial attack revealed normal GH response to stimulation test. It is suggested that cortisol deficiency was responsible for the severe hypoglycemic coma and subnormal GH response. A similar mechanism is speculated for the normal growth observed in some patients with apparent deficiency of anterior pituitary hormones, including GH. The possibility of permanent ACTH deficiency and transitory GH deficiency following hypophysitis is discussed.

Isolated Adrenocorticotropin Deficiency as a Rare Cause of Hypoglycaemia in Children

“…7], In our patient a high-resolution CT scan and MRI were not contributory and failed to demonstrate any anatomi cal abnormalities in the sella and suprasella regions. The role of autoimmunity in the pathogenesis of the condition has been suggested by Bevan et al [ 16] and Sandler and Proudfoot [ 17], This has also been proposed by Hochberg et al [4], who have reported a 9-year-old girl with isolated ACTH deficiency and transient growth hormone deficien cy. Our patient did not have organ-specific, including pituitary cells, antibodies.…”

Das hypophys�re Koma

“…Insbesondere Kinder können durch den somatotropen (GH) und kortikotropen (ACTH) Ausfall eine Hypoglykämie entwickeln [12]. Der Hämatokrit und die Kreatininkinase können durch die Dehydratation und letztere durch eine schwere sekundäre Hypopthyreose erhöht sein.Der vorwiegend durch die Hypothyreose induzierte mögliche Zellzerfall der Skelettmuskulatur äußert sich in einer erhöhten LDH,GOT und GPT.Darüber hinaus kann eine respiratorische Azidose bestehen.…”

Isolated Adrenocorticotropic Hormone Deficiency not Always Permanent

“…9,10 It might be associated with transient growth hormone (GH) deficiency or thyroid disorders. 11,12 Also, various toxins were associated with the deficiency. 13 In this communication, we describe two patients with Isolated Adrenocorticotrophic Hormone (ACTH) deficiency that experienced two different outcomes (transient vs. permanent) with an attempt to highlight the importance of understanding such disorders and its aetio-pathophysiology.…”