Acute Secondary Adrenal Insufficiency Misdiagnosed as Acute Cholecystitis

Hypopituitarism refers to insufficient secretion of the pituitary hormones. Patients with acute adrenocorticotropic hormone (ACTH) deficiency may be presented with fatigue, dizziness, orthostatic hypotension, hypoglycemia, nausea, vomiting, or nonspecific abdominal pain. This study described an unusual case of hypopituitarism in a patient who presented with general abdominal pain, abdominal tenderness, nausea, vomiting, hypotension, and hypoglycemia. At first, the patient was admitted with the diagnosis of acute cholecystitis, but after treatment of hypopituitarism and adrenal insufficiency, his symptoms resolved completely, without the need for surgery. Hypopituitarism and secondary adrenal insufficiency should be considered in the differential diagnosis of the patients who present with acute abdomen, hypotension, or hypoglycemia.

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

BMJ Case Reports ◽

10.1136/bcr-2021-243093 ◽

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.

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Pazopanib-associated secondary adrenal insufficiency in a patient with malignant solitary fibrous tumor

Journal of Oncology Pharmacy Practice ◽

10.1177/10781552211016081 ◽

2021 ◽

pp. 107815522110160

Author(s):

Muhammed Muhiddin Er ◽

Murat Araz ◽

Meryem Karabacak ◽

Muzaffer Uğraklı ◽

Melek Karakurt Eryılmaz ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Solitary Fibrous Tumor ◽

Single Case ◽

Soft Tissue Sarcomas ◽

Pituitary Hormones ◽

Secondary Adrenal Insufficiency ◽

Primary Adrenal Insufficiency ◽

Hypoglycemic Attack ◽

Fibrous Tumor

Introduction Pazopanib is an agent that is being successfully used in soft tissue sarcomas. Some endocrine side effects may develop during pazopanib treatment. Here, we presented a case diagnosed with secondary adrenal insufficiency while being investigated for etiology of hypoglycemia which developed after pazopanib. Case report A 69-year-old male patient was operated in June 2019 due to a lung mass 26 × 18 × 10 cm in size. Pathological diagnosis revealed a solitary fibrous tumor with malignant behavior. The patient received three lines of chemotherapy. After pazopanib treatment, a hypoglycemic attack was reported. Management and outcome: Blood cortisol and ACTH (Adrenocorticotropic hormone) levels were not increased at the time of the hypoglycemic attack, and levels of other pituitary hormones were found to be normal. Electrolyte levels were in normal range. Since the counteracting hormone did not reach a sufficient level, it was considered secondary adrenal insufficiency. Hypoglycemic attacks did not occur during follow-up while taking steroid therapy and pazopanib. Discussion A single case of primary adrenal insufficiency has been reported in the literature. We here present a case who developed hypoglycemia after pazopanib and was diagnosed with drug-associated secondary adrenal insufficiency. When hypoglycemia develops during pazopanib treatment, we must be aware of adrenal insufficiency.

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Addison’s Disease Presenting with Abdominal Pain

Acute Medicine Journal ◽

10.52964/amja.0141 ◽

2006 ◽

Vol 5 (3) ◽

pp. 102-103

Author(s):

Tejal Desai ◽

◽

Tristan Richardson ◽

Keyword(s):

Quality Of Life ◽

Abdominal Pain ◽

Life Expectancy ◽

Adrenal Insufficiency ◽

Unusual Case ◽

Primary Adrenal Insufficiency ◽

Prompt Treatment ◽

Bilateral Destruction ◽

Important Disease

Primary Adrenal Insufficiency is due to bilateral destruction of the adrenal cortex and has a prevalence of approximately 40-60 per million adults. 1 The commonest cause is autoimmune. 1 Prompt treatment not only restores quality of life but also a normal life expectancy. 2 Here we present an unusual case of primary adrenal insufficiency, which illustrates how such an important disease often provides a diagnostic conundrum.

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Isolated adrenocorticotropic hormone deficiency and secondary adrenal insufficiency with hypercalcemia in a patient undergoing long‒term hemodialysis

Nihon Toseki Igakkai Zasshi ◽

10.4009/jsdt.54.489 ◽

2021 ◽

Vol 54 (9) ◽

pp. 489-494

Author(s):

Mari Okajima ◽

Noritaka Onoda ◽

Kaori Sato ◽

Midori Koga ◽

Akio Ogawa ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Adrenocorticotropic Hormone ◽

Hormone Deficiency ◽

Secondary Adrenal Insufficiency ◽

Isolated Adrenocorticotropic Hormone Deficiency

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Secondary Adrenal Insufficiency due to Opiate Therapy – Another Differential Diagnosis Worth Consideration

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/s-0029-1202851 ◽

2009 ◽

Vol 117 (10) ◽

pp. 649-651 ◽

Cited By ~ 27

Author(s):

K-E. Schimke ◽

P. Greminger ◽

M. Brändle

Keyword(s):

Differential Diagnosis ◽

Adrenal Insufficiency ◽

Secondary Adrenal Insufficiency

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Repetitive and continuous administration of human corticotropin releasing factor to human subjects

Acta Endocrinologica ◽

10.1530/acta.0.1120157 ◽

1986 ◽

Vol 112 (2) ◽

pp. 157-165 ◽

Cited By ~ 9

Author(s):

J. Schopohl ◽

A. Hauer ◽

T. Kaliebe ◽

G. K. Stalla ◽

K. von Werder ◽

...

Keyword(s):

Adrenal Insufficiency ◽

Bolus Injection ◽

Human Subjects ◽

Normal Subjects ◽

Pituitary Hormones ◽

Corticotropin Releasing Factor ◽

Secondary Adrenal Insufficiency ◽

Continuous Administration ◽

Pulsatile Administration

Abstract. ACTH secretion was studied in response to repetitive and continuous administration of human corticotropin releasing factor (CRF) in 14 healthy volunteers and 2 patients with secondary adrenal insufficiency. ACTH increases during repetitive CRF administration were within the same range in normal subjects independent of the intervals (60– 180 min) between the CRF pulses (100 μg iv). When CRF was infused continuously (100 μg/h for 3 h) after an initial CRF bolus injection (100 μg iv), ACTH and cortisol remained elevated during the infusion at a nearly constant level (ACTH: 60 ± 5 pg/ml; cortisol: 21.2 ± 1 μg/dl; x̄ ± se). A second CRF bolus injection at the end of the infusion did not lead to a significant further increase of ACTH and cortisol levels. This shows that there is no desensitisation or depletion of a ready releasable pool, as it is observed with other pituitary hormones after releasing hormone stimulation. Pulsatile administration of CRF in 2 patients with secondary adrenal insufficiency due to previous cortisol or glucocorticoid excess, respectively, revealed a blunted response to the first pulse which became normal after the following pulses. The latter could not be sustained until the next morning without CRF given overnight. These findings point to a hypothalamic defect being the cause of hypocortisolism after long-term cortisol suppression.

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SECONDARY ADRENAL INSUFFICIENCY MIMICKING ABDOMINAL CAUSE OF RECURRENT ABDOMINAL PAIN IN A PREPUBERTAL GIRL

Facta Universitatis Series Medicine and Biology ◽

10.22190/fumb191223016m ◽

2020 ◽

pp. 101

Author(s):

Ana Milenović ◽

Ljiljana Šaranac ◽

Vasiliki Toli ◽

Dragana Ilić ◽

Zlatko Đurić

Keyword(s):

Abdominal Pain ◽

Adrenal Insufficiency ◽

Recurrent Abdominal Pain ◽

Causative Factor ◽

Growth Monitoring ◽

Secondary Adrenal Insufficiency ◽

Reactive Protein ◽

Facial Defects ◽

Magnetic Resonance Imaging Mri ◽

Low Cortisol

Recurrent abdominal pain (RAP) in children is defined as at least three episodes of pain that occur over at least three months and affect the child's ability to perform normal activities. The prevalence of recurrent abdominal pain in a population of schoolchildren varies from 10% to even 45%. Pituitary disorders are rarely considered as causative factor in children with abdominal pain, especially in absence of midline facial defects and in case of emergency, when growth monitoring is neglected or not performed carefully. Herein we report an unusual case of RAP caused by secondary adrenal insufficiency. An 8-year-old girl was hospitalized repeatedly because of RAP. Biological parameters including white blood cell count, hemoglobin value, C-reactive protein, glucose, electrolytes were within the normal range. Low cortisol combined with low ACTH values was the clue for diagnosis. The magnetic resonance imaging (MRI) of the pituitary region revealed anterior pituitary hypoplasia and pituitary stalk interruption. To the best of our knowledge, this is the first report of child with RAP caused by pituitary disorder. Possible inherited, autoimmune and post-traumatic causative factors are discussed.

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Secondary Adrenal Insufficiency: New Aspects of Diagnosis and Therapy

Doctor Ru ◽

10.31550/1727-2378-2021-20-2-51-59 ◽

2021 ◽

Vol 20 (2) ◽

pp. 51-59

Author(s):

N.F. Nuralieva ◽

◽

M.Yu. Yukina ◽

E.A. Troshina ◽

◽

...

Keyword(s):

High Risk ◽

Adrenal Insufficiency ◽

Adrenocorticotropic Hormone ◽

Risk Groups ◽

Glucocorticoid Therapy ◽

Check Point ◽

Secondary Adrenal Insufficiency ◽

Severe Condition ◽

Key Points ◽

Check Point Inhibitors

Objective of the Review: To discuss the current idea of the aetiology, diagnosis and management of secondary adrenal insufficiency (SAI). Key Points. The article describes key causes of the disease, including iatrogenic causes, discusses the widely studied effect of adrenocorticotropic hormone suppression by glucocorticoids and a lesser studied autoimmune hypophysitis induced by check point inhibitors. Special aspects of SAI diagnosis, principles of replacement therapy and cases of unjustified glucocorticoids prescription are given in detail. Risk classification for disease development if glucocorticoids are prescribed for other conditions is presented; an algorithm for management of this group of patients is described. Conclusion. If diagnosed untimely and treated incorrectly, SAI is a severe condition with a high risk of addisonian crisis and death. As the diagnosis is very often challenging, due vigilance is warranted, especially in high-risk groups (patients on long-lasting glucocorticoid therapy). At the same time, unjustified treatment should be avoided if diagnosis is not verified. Keywords: secondary adrenal insufficiency, secondary hypoadrenocorticism, aetiological diagnostics, glucocorticoid therapy.

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