Isolated adrenocorticotrophic hormone (ACTH) deficiency associated with acute adrenal crisis

Abstract

Summary:A 37 year old black female presented with congestive cardiac failure, 2 months postpartum. She developed spontaneous hypoglycaemia and symptoms of acute adrenal crisis (hypotension, nausea, abdominal pain and tachycardia with small thready pulse), which responded to i.v. dextrose, sodium chloride and hydrocortisone. Biochemical investigations revealed low serum cortisol and plasma adrenocorticotrophic hormone (ACTH) levels. The patient initially showed an impaired cortisol response to intramuscular aqueous tetracosactrin, but an exuberant response after priming with intramuscular tetracosactrin depot. These findings, together with the normal remainiing pituitary function, led us to conclude that this patient had isolated ACTH deficiency associated with congestive cardiac failure and acute adrenal crisis.

Deep negative T waves associated with reversible left ventricular dysfunction in acute adrenal crisis

“…Cardiovascular complications have been associated with acute adrenal crisis [7,8]. Cardiac arrest can occur from ventricular tachycardia due to prolongation of the QT interval.…”

Takotsubo Cardiomyopathy during Acute Adrenal Crisis due to Isolated Adrenocorticotropin Deficiency

“…This state is usually termed adrenal crisis. However, cardiomyopathy induced by adrenal crisis is very uncommon (11)(12)(13)(14)(15)(16)(17)(18).…”

Isolated corticotropin deficiency in chronic alcoholism

“…The pathophysiology remains unclear. The clinical presentation has included hypoglycaemia 12 , cramps 13 , anaemia 14 , deterioration of mental function 15 , myoclonus and seizures 16 , and severe hypotensive crisis 17 . Hyponatraemia is usually present, re¯ecting the de®ciency of glucocorticoid action to enhance free water excretion 18 .…”