Isolated Adrenocorticotropic Hormone Deficiency and Primary Hypothyroidism in a Patient Undergoing Long-Term Hemodialysis: A Case Report and Literature Review

Ohara, Nobumasa; Kobayashi, Michi; Tuchida, Masafumi; Koda, Ryo; Yoneoka, Yuichiro; Iino, Noriaki

doi:10.12659/ajcr.922376

Cited by 2 publications

(1 citation statement)

References 22 publications

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“…These clinical manifestations, though not typical of ICAI, seem to be closely related to the hypoadrenal condition because they disappear upon the start of steroid replacement therapy. Primary infertility ( 51 ), Crohn’s disease ( 52 ), myasthenia gravis ( 53 ), polycystic kidney disease ( 54 ), spinocerebellar ataxia type 3 ( 55 ), benign endocranic hypertension ( 56 ), Down syndrome ( 57 ), cognitive impairment and mental health disorders ( 58 , 59 ), chronic opiate use ( 60 ) and haemodialysis ( 61 ) have also been reported in conjunction with ICAI, as well as paraneoplastic syndrome ( 55 ).…”

Section: Isolated Central Adrenal Insufficiencymentioning

confidence: 99%

Isolated anterior pituitary dysfunction in adulthood

et al. 2023

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Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and prolactin deficiency. Patients with hypopituitarism suffer from an increased disability and sick days, resulting in lower health status, higher cost of care and an increased mortality. In particular during adulthood, isolated pituitary deficits are not an uncommon finding; their clinical picture is represented by vague symptoms and unclear signs, which can be difficult to properly diagnose. This often becomes a challenge for the physician. Aim of this narrative review is to analyse, for each anterior pituitary deficit, the main related etiologies, the characteristic signs and symptoms, how to properly diagnose them (suggesting an easy and reproducible step-based approach), and eventually the treatment. In adulthood, the vast majority of isolated pituitary deficits are due to pituitary tumours, head trauma, pituitary surgery and brain radiotherapy. Immune-related dysfunctions represent a growing cause of isolated pituitary deficiencies, above all secondary to use of oncological drugs such as immune checkpoint inhibitors. The diagnosis of isolated pituitary deficiencies should be based on baseline hormonal assessments and/or dynamic tests. Establishing a proper diagnosis can be quite challenging: in fact, even if the diagnostic methods are becoming increasingly refined, a considerable proportion of isolated pituitary deficits still remains without a certain cause. While isolated ACTH and TSH deficiencies always require a prompt replacement treatment, gonadal replacement therapy requires a benefit-risk evaluation based on the presence of comorbidities, age and gender of the patient; finally, the need of growth hormone replacement therapies is still a matter of debate. On the other side, prolactin replacement therapy is still not available. In conclusion, our purpose is to offer a broad evaluation from causes to therapies of isolated anterior pituitary deficits in adulthood. This review will also include the evaluation of uncommon symptoms and main etiologies, the elements of suspicion of a genetic cause and protocols for diagnosis, follow-up and treatment.

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Section: Isolated Central Adrenal Insufficiencymentioning

confidence: 99%

Isolated anterior pituitary dysfunction in adulthood

et al. 2023

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A Rare Cause of Hypotension in Routine Hemodialysis: Secondary Adrenal Insufficiency

Altunok,

Kızıltunç,

Çankaya

et al. 2024

Seminars in Dialysis

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Hypotension is a common complication during hemodialysis that develops due to high ultrafiltration rate and sometimes requires intravenous fluid replacement. Intradialytic hypotension may reduce the effectiveness of dialysis and contributes to hemodialysis‐related morbidity and mortality. Adrenal insufficiency is one of the causes of hypotension in the community. Our case was diagnosed with end‐stage renal failure and was undergoing routine hemodialysis with a central venous catheter 3 days a week. Upon the patient's hypotension attacks during the dialysis sessions and hypoglycemia attacks in the follow‐ups, the morning cortisol was 6.2 μg/dL. Adrenocorticotropic hormone was 39 pg/mL, and testosterone was 0.0442 ng/mL. Adrenocorticotropic hormone stimulation test was performed on the patient with 250 mcg tetracosactide. The patient did not show adequate cortisol response, was detected to have partial empty sella on pituitary magnetic resonance imaging, and was diagnosed with secondary adrenal insufficiency, and then the hemodialysis hypotension improved with prednisolone treatment. We present a case of adrenal insufficiency, which is a rare cause of hypotension in patients on routine hemodialysis.

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Isolated Adrenocorticotropic Hormone Deficiency and Primary Hypothyroidism in a Patient Undergoing Long-Term Hemodialysis: A Case Report and Literature Review

Cited by 2 publications

References 22 publications

Isolated anterior pituitary dysfunction in adulthood

Isolated anterior pituitary dysfunction in adulthood

A Rare Cause of Hypotension in Routine Hemodialysis: Secondary Adrenal Insufficiency

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