Adrenal Insufficiency After Medical Therapy for Prolactin and Adrenocorticotropic Hormone Co-Producing Pituitary Macroadenoma Without Hypercortisolism

2001 ◽  
Vol 11 (6) ◽  
pp. 443-446
Author(s):  
Ken C. Chiu ◽  
Pejman Cohan ◽  
Dorothy Martinez ◽  
Lisa Moore
Keyword(s):  
Adrenal Insufficiency ◽  
Medical Therapy ◽  
Adrenocorticotropic Hormone ◽  
Pituitary Macroadenoma

scholarly journals Abdominal pain as an initial symptom of isolated ACTH deficiency induced by nivolumab in a patient with malignant mesothelioma

2021 ◽  
Vol 14 (7) ◽  
pp. e243093
Author(s):  
Koichi Hata ◽  
Chikara Sakaguchi ◽  
Michiko Tsuchiya ◽  
Yukio Nagasaka
Keyword(s):  
Abdominal Pain ◽  
Adverse Events ◽  
Adrenal Insufficiency ◽  
Malignant Mesothelioma ◽  
Adrenocorticotropic Hormone ◽  
Hormone Deficiency ◽  
Initial Symptom ◽  
Isolated Acth Deficiency ◽  
Wide Range ◽  
Isolated Adrenocorticotropic Hormone Deficiency

Used for a wide range of cancers, nivolumab has been reported to cause immune-related adverse events, including isolated adrenocorticotropic hormone deficiency (IAD). We report an 81-year-old woman with malignant mesothelioma who presented with abdominal pain after eight courses of nivolumab therapy, leading to the diagnosis of nivolumab-induced IAD. We should consider adrenal insufficiency (AI) when a patient on nivolumab complains of abdominal pain and has no other explanatory findings. Infusion-resistant hypotension and hyponatraemia can further suggest AI.

scholarly journals PRIMARY ADRENAL INSUFFICIENCY SECONDARY TO CHRONIC POSACONAZOLE USE

2020 ◽  
Vol 6 (2) ◽  
pp. e62-e64
Author(s):  
Daniela Pirela Araque ◽  
Gabriela Zuniga ◽  
Alejandro R. Ayala
Keyword(s):  
Computed Tomography ◽  
Adrenal Insufficiency ◽  
Side Effect ◽  
Adrenocorticotropic Hormone ◽  
Fungal Infections ◽  
Plasma Renin ◽  
Primary Adrenal Insufficiency ◽  
The Third ◽  
Abdominal Computed Tomography ◽  
Morning Cortisol

Objective: Posaconazole (PSO) is commonly used in the treatment of invasive fungal infections. PSO-induced primary adrenal insufficiency (PAI) is rare, and we present what we think to be the third case report of its incidence. We want to bring awareness to this rare but significant side effect that can impact management and monitoring of patients on this medication. Methods: After clinical assessment, the patient was evaluated with diagnostic studies including measurements of cortisol, adrenocorticotropic hormone, renin activity, and aldosterone levels. Imaging studies such as abdominal computed tomography were also performed. Results: A 65-year-old man with a history of hemophagocytic lymphohistiocytosis on a dexamethasone taper, complicated with mucormycosis on PSO presented to the emergency department with weakness, fatigue, decreased appetite, orthostatic hypotension, low morning cortisol (0.4 μg/dL), low adrenocorticotropic hormone (3.4 pg/mL), elevated plasma renin (16.7 ng/mL/hour), and low-normal aldosterone (1.7 ng/dL). Abdominal computed tomography imaging revealed bilaterally intact adrenal glands. A diagnosis of PSO-induced PAI was made. Fludrocortisone was initiated in addition to glucocorticoids with improvement of fatigue, appetite, blood pressure, and normalization of sodium and potassium. A month after discontinuing PSO, steroids and fludrocortisone were discontinued with measured morning cortisol of 13 μg/dL and an adrenocorticotropic hormone level of 53.9 pg/mL, both normal. Conclusion: Available data suggest that the adverse effect profile of PSO is more favorable than other triazoles. However, our case is the third report suggesting that PAI may be an underrecognized side effect. Awareness of this complication is particularly important in patients with severe or resistant fungal infections.

scholarly journals Therapeutic Patient Education for Adrenal Insufficiency under COVID-19 Pandemic Conditions

2020 ◽  
Author(s):  
Tina Kienitz ◽  
Stefanie Hahner ◽  
Stephanie Burger-Stritt ◽  
Marcus Quinkler
Keyword(s):  
Patient Education ◽  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Medical Therapy ◽  
Medical Personnel ◽  
Daily Basis ◽  
Background Information ◽  
Therapeutic Patient Education ◽  
Dose Adaptation ◽  
Glucocorticoid Replacement Therapy

AbstractAdrenal insufficiency (AI) requires life-long treatment with glucocorticoid replacement therapy. Over- or under-substitution carries the risk of increased morbidity in the form of side effects or adrenal crises. Glucocorticoid replacement therapy needs to be flexible with dose adaptation in special situations. This could not be managed by medical personnel on a daily basis, but requires an educated patient who has a good knowledge of the disease, understands his medical therapy and is able to perform situational dose adaptation. The rarity of the disease in combination with the need to respond to stressful situations with rapid glucocorticoid dose adjustment underlines that a well-trained patient is crucial for optimal management of the disease.In this literature review we provide background information further clarifying the need of education in patients with AI including the current shortcomings of medical therapy and of the treatment of patients with AI. We outline the aims of therapeutic patient education, present the concept of structured patient education in Germany, and discuss available results of patient group education programs. Furthermore, we propose strategies how therapeutic patient education for adrenal insufficiency can be organized under COVID-19 pandemic conditions.

scholarly journals Isolated Adrenocorticotropin Deficiency Associated with Delirium and Takotsubo Cardiomyopathy

2012 ◽  
Vol 2012 ◽  
pp. 1-5 ◽  
Author(s):  
Masanori Murakami ◽  
Noriko Matsushita ◽  
Rie Arai ◽  
Naohiro Takahashi ◽  
Ryuki Kawamura ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Replacement Therapy ◽  
Takotsubo Cardiomyopathy ◽  
Mental State ◽  
Adrenocorticotropic Hormone ◽  
Myocardial Dysfunction ◽  
Laboratory Data ◽  
Adrenal Crisis ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency

We report a 65-year-old woman with isolated adrenocorticotropic hormone (ACTH) deficiency. The patient was transported to the emergency outpatient department by ambulance complaining of malaise and nausea. Because her laboratory data revealed hyponatremia, we performed endocrinological examinations and diagnosed isolated ACTH deficiency. After admission, she went into a delirious state and suffered from takotsubo cardiomyopathy due to adrenal insufficiency. Replacement therapy with hydrocortisone sufficiently improved her delirium and cardiomyopathy. We conclude that her unstable mental state and myocardial dysfunction were closely related to adrenal insufficiency and suggest that adrenal crisis may cause delirium and Takotsubo cardiomyopathy.

scholarly journals Diverse etiologies, diagnostic approach, and management of primary adrenal insufficiency in pediatric age

2021 ◽  
Vol 26 (3) ◽  
pp. 149-157
Author(s):  
Han-Wook Yoo
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenocorticotropic Hormone ◽  
Molecular Genetic ◽  
Pediatric Age ◽  
Steroid Biosynthesis ◽  
Primary Adrenal Insufficiency ◽  
Laboratory Findings ◽  
Developmental Abnormalities ◽  
Monogenic Disorders ◽  
The Past

Primary adrenal insufficiency (PAI) in pediatric age is a rare, but potentially fatal condition caused by diverse etiologies including biochemical defects of steroid biosynthesis, developmental abnormalities of the adrenal gland, or reduced responsiveness to adrenocorticotropic hormone. Compared to adult PAI, pediatric PAI is more often the result of genetic (monogenic, syndromic disorders) than acquired conditions. During the past decade, rare monogenic disorders associated with PAI have helped unravel the underlying novel molecular genetic mechanism. The diagnosis of adrenal insufficiency in children and young infancy is often challenging, usually based on clinical suspicion and endocrine laboratory findings. Pediatric endocrinologists sometimes encounter therapeutic difficulty in finding the balance between undertreatment and overtreatment, determining how to optimize the dose over the patient’s lifetime, and maximizing mimicry of normal cortisol secretion with glucocorticoid replacement therapy.

scholarly journals New Cutoffs for the Biochemical Diagnosis of Adrenal Insufficiency after ACTH Stimulation using Specific Cortisol Assays

2021 ◽  
Vol 5 (4) ◽  
Author(s):  
Bradley R Javorsky ◽  
Hershel Raff ◽  
Ty B Carroll ◽  
Alicia Algeciras-Schimnich ◽  
Ravinder Jit Singh ◽  
...  
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenocorticotropic Hormone ◽  
Serum Cortisol ◽  
Serum Samples ◽  
Acth Stimulation ◽  
Normal Response ◽  
Baseline Cortisol ◽  
Biochemical Diagnosis ◽  
Antibody Assays ◽  
Stimulation Tests

Abstract Context The normal cortisol response 30 or 60 minutes after cosyntropin (ACTH[1–24]) is considered to be ≥18 μg/dL (500 nmol/L). This threshold is based on older serum cortisol assays. Specific monoclonal antibody immunoassays or LC-MS/MS may have lower thresholds for a normal response. Objective To calculate serum cortisol cutoff values for adrenocorticotropic hormone (ACTH) stimulation testing with newer specific cortisol assays. Methods Retrospective analysis of ACTH stimulation tests performed in ambulatory and hospitalized patients suspected of adrenal insufficiency (AI). Serum samples were assayed for cortisol in parallel using Elecsys I and Elecsys II immunoassays, and when volume was available, by Access immunoassay and LC-MS/MS. Results A total of 110 patients were evaluated. Using 18 μg/dL as the cortisol cutoff after ACTH stimulation, 14.5%, 29%, 22.4%, and 32% of patients had a biochemical diagnosis of AI using the Elecsys I, Elecsys II, Access, and LC-MS/MS assays, respectively. Deming regressions of serum cortisol were used to calculate new cortisol cutoffs based on the Elecsys I cutoff of 18 μg/dL. For 30-minute values, new cutoffs were 14.6 μg/dL for Elecsys II, 14.8 μg/dL for Access, and 14.5 μg/dL for LC-MS/MS. Baseline cortisol <2 μg/dL was predictive of subnormal stimulated cortisol values. Conclusion To reduce false positive ACTH stimulation testing, we recommend a new serum cortisol cutoff of 14 to 15 μg/dL depending on the assay used (instead of the historical value of 18 μg/dL with older polyclonal antibody assays). Clinicians should be aware of the new cutoffs for the assays available to them when evaluating patients for AI.

CLINICAL PRESENTATION AND OUTCOMES OF OPIOID-INDUCED ADRENAL INSUFFICIENCY

2020 ◽  
Vol 26 (11) ◽  
pp. 1291-1297 ◽  
Author(s):  
Taoran Li ◽  
Diane Donegan ◽  
W. Michael Hooten ◽  
Irina Bancos
Keyword(s):  
Adrenal Insufficiency ◽  
Adrenocorticotropic Hormone ◽  
Clinical Manifestations ◽  
Dehydroepiandrosterone Sulfate ◽  
Stimulation Test ◽  
Glucocorticoid Treatment ◽  
Hypothalamic Pituitary Adrenal ◽  
Academic Center ◽  
High Level ◽  
Cosyntropin Stimulation Test

Objective: Opioid-induced adrenal insufficiency (OIAI) may develop in patients treated with chronic opioids due to suppression of the hypothalamic-pituitary-adrenal axis. Our objective was to describe the clinical manifestations, biochemical presentation, and clinical course of OIAI. Methods: A retrospective study of adults diagnosed with OIAI between 2006 and 2018 at an academic center. Opioid daily dose was converted into morphine milligram equivalents (MMEs). Results: Forty patients (women, n = 29 [73%]) taking chronic opioids at a daily median MME dose of 105 (60 to 200) mg and median duration of 60 (3 to 360) months were diagnosed with OIAI. Patients reported fatigue (n = 29, 73%), musculoskeletal pain (n = 21, 53%), and weight loss (n = 17, 53%) for a median of 12 (range, 1 to 132) months prior to diagnosis, and only 7.5% (n = 3) of patients were identified with OIAI through case detection. Biochemical diagnosis of OIAI was based on ( 1) low morning cortisol, baseline adrenocorticotropic hormone and/or dehydroepiandrosterone sulfate in 59% (n = 26) of patients or ( 2) abnormal cosyntropin stimulation test in 41% (n = 14) of patients. With glucocorticoid replacement, 16/23 (70%) patients with available follow-up experienced improvement in symptoms. Opioids were tapered or discontinued in 15 patients, of whom 10 were followed for adrenal function and of which 7 (70%) recovered from OIAI. Conclusion: Minimum daily MME in patients diagnosed with OIAI was 60 mg. OIAI causes significant morbidity, and recognition requires a high level of clinical suspicion. Appropriate glucocorticoid treatment led to improvement of symptoms in 70%. Resolution of OIAI occurred following opioid cessation or reduction. Abbreviations: ACTH = adrenocorticotropic hormone; CST = cosyntropin stimulation test; DHEAS = dehydroepiandrosterone sulfate; HPA = hypothalamic-pituitary-adrenal; MME = morphine milligram equivalent; OIAI = opioid-induced adrenal insufficiency

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