Transient Adenocorticotropic Hormone deficiency in an infant

Abstract

Background: Isolated Adenocorticotropin Hormone (ACTH) deficiency is a rare disorder, characterized by secondary adrenal insufficiency with a low or absent cortisol production, normal secretion of other pituitary hormones and absence of structural pituitary defects. Case summary: The patient was the product of a 28 weeks gestation, clomiphen induced to a 40-year-old, gestational diabetic mother. He was ventilated for 30 days, and was diagnosed to have grade IV Retina of Prematurity (ROP). He suffered from recurrent attacks of hypoglycemic, blood sugar of 1.6 mmol/L, low serum cortisol 65 nmol/L (normal; 150-630), and ACTH of 1.5 pmol/L (normal; 1.6-13.9), with suppressed serum insulin and normal thyroid, growth hormone and gonadal functions. Magnetic Resonance Imaging (MRI) was unremarkable. He was started on hydrocortisone 2.5 mg twice daily for two years, which was then slowly tapered and stopped. Later Serum cortisol was 175 nmol/L, and ACTH of 5.5 pmol/L with a normal shot ACTH stimulation test. Conclusions: This case of a premature baby who presented with recurrent hypoglycemia had an isolated ACTH deficiency that proved to be transient. The pediatricians need to be aware of the existence of such condition.

Auxological, Clinical, and MRI Abnormalities in Pediatric Patients With Isolated Growth Hormone Deficiency

“…Various types of neurohypophyseal abnormalities have been identified in MRI scans of patients with isolated GHD. Similar to our findings, the most common type of abnormality reported in the literature in patients with isolated GHD is pituitary hypoplasia, which is characterized by a small or underdeveloped pituitary gland [17]. In a study reported by Chen et al, pituitary hypoplasia was the most frequent MRI abnormality in their study on pediatric patients with GHD [18,19].…”

Isolated Adrenocorticotropic Hormone Deficiency not Always Permanent

“…[2][3][4][5][6][7][8][9][10][14][15][16] Insulin Tolerance Test (ITT) is considered the gold standard test to evaluate the hypothalamic pituitary adrenal (HPA), but has its disadvantages in clinical practice and that is the reason we prefer to the synacthen test, in most cases. 17 The patients presented here 18,19 were diagnosed as having isolated Adrenocorticotrophic Hormone (ACTH) deficiency according to the typical endocrinological findings as well as hormonal revaluation after a sufficient time interval on replacement therapy. The possible path physiologic mechanisms leading to this is poorly understood.…”