Isolated corticotropin deficiency in chronic alcoholism

Abstract

Three patients who chronically abused alcohol were found to be hyponatraemic with normal plasma potassium. The first had been admitted with confusion and weight loss, the second with hypotension and sepsis, and the third with confusion and hypoglycaemia-induced seizures. All three patients had a subnormal cortisol response in the short synacthen test; however, the plasma cortisol after three days of tetracosactrin administration was greater than 550 nmol/L. Baseline corticotropin levels were less than 10 pg/mL in all three. No structural lesions of the hypothalamo-pituitary tract were found and there was no evidence of other endocrinopathies. Glucocorticoid replacement therapy led to the resolution of hyponatraemia and hypoglycaemia, where present, and to clinical improvement. The two surviving patients remained hypocortisolaemic in the long term, without recurrence of hyponatraemia or hypoglycaemia. The features of isolated corticotropin deficiency are easily confused with other effects of chronic alcohol abuse. In alcoholic patients with unexplained hyponatraemia, hypoglycaemia or haemodynamic instability, a short tetracosactrin test is advisable.

Isolated corticotrophin deficiency

“…Primary infertility [19], Crohn's disease [20], myasthenia gravis [21], polycystic kidney disease [22], spinocerebellar ataxia type 3 [23] and benign endocranic hypertension [24] have also been reported in conjunction with IAD. Lastly, IAD is not infrequent in chronic alcoholism [25,26] and, as in patients with the above-mentioned disorders, should be considered if more typical hypoadrenal symptoms are present. Likewise, IAD should also be kept in mind in patients with other autoimmune diseases: IAD due to lymphocytic hypophysitis has often been described associated with autoimmune hypothyroidism [27,28] and, occasionally, with Graves' disease [29], type 1 diabetes [30] and polyglandular autoimmune failure [31].…”

Rare clinical problem — isolated ACTH deficiency associated with chronic alcohol abuse

“…The other causes of IAD include pituitary trauma [2], primary empty saddle [11], and cases of possible "exhaustion" of central CRH/ACTH resources, resulting in secondary adrenal insufficiency [12]. Several cases of IAD related to chronic alcoholism were also described [13][14][15]. In some cases, the aetiology remains unknown.…”

“…The results of basic laboratory tests with hyponatremia refractory to treatment, normokalaemia, and anemia were also comparable. Typically for IAD, an insidious and non-specific clinical presentation and laboratory results delayed the proper diagnosis [1,2,14]. We tried to establish the aetiology of IAD in our patients.…”

“…The mechanism of such suppression is not clear, but a growing body of evidence indicates that alcohol abuse produces persistent dysregulation of several neurotransmitters and neuropeptides, including increased activity of gamma-aminobutyric acid (GABA), endogenous opiate (EOP), and atrial natriuretic peptide (ANP), which can inhibit the HPA axis [19]. In view of the medical literature, alcoholism may be a rare cause of IAD [13][14][15]. Kearney et al [14] reported the history of 3 patients who chronically abused alcohol, diagnosed with IAD.…”

“…In view of the medical literature, alcoholism may be a rare cause of IAD [13][14][15]. Kearney et al [14] reported the history of 3 patients who chronically abused alcohol, diagnosed with IAD. All were over 40 years old, 2 of them were males, all presented confusion, anorexia, and one had low blood pressure.…”