scholarly journals MON-243 Atypical Presentation of Isolated Adrenocorticotropic Hormone Deficiency and Sheehan’s Syndrome

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Zahira Marie Lugo López ◽  
Nadyeschka Angelique Rivera Santana ◽  
Andrea del Toro Diez ◽  
Michelle Marie Mangual Garcia ◽  
Ernesto Sola Sanchez ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Adrenocorticotropic Hormone ◽  
Brain Mri ◽  
Pituitary Hormones ◽  
Hormone Deficiency ◽  
Normal Brain ◽  
Sheehan’S Syndrome ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Sheehan's Syndrome

Abstract Introduction: Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare pituitary hormone deficiency defined by secondary adrenal insufficiency and normal secretion of all other pituitary hormones. Patients present with fatigue, weakness, weight loss, anorexia, nausea, low cortisol levels and low ACTH levels. Isolated ACTH deficiency is more common in males and usually presents in the fifth decade of life. Main mechanisms involved in the pathogenesis are genetics and autoimmune causes, traumatic brain injury and infarction of the pituitary postpartum, known as Sheehan’s syndrome. Sheehan’s syndrome is characterized by postpartum hemorrhage, failure to lactate and menstrual irregularities and it can occur from immediate postpartum period to years after delivery. The most common hormone deficiencies are prolactin and growth hormone. Empty sella is the most common finding on brain MRI. We are reporting a case of a woman in her third decade with isolated ACTH deficiency due to Sheehan’s syndrome two years postpartum, able to lactate, with normal menses and normal brain MRI. Clinical Case: A 33-year-old woman G3P3A0 with hypothyroidism who was referred to Endocrinology clinics due to tiredness, fatigue and weakness. She reported postpartum hemorrhage requiring 4 PRBC transfusions and IV steroids after last pregnancy 5 years ago. Patient was able to lactate after pregnancy and continued in her usual state of health until 3 years ago when she referred loss of consciousness with traumatic head injury due to hypoglycemia. At Endocrinology office physical examination and vital signs were unremarkable, including no blood pressure or heart rate variations with positional changes. Despite hypothyroidism being adequately controlled, she continued with extreme fatigue and weakness affecting her quality of life, for which cortisol and ACTH levels were ordered. Laboratories showed normal electrolytes, negative autoantibodies, cortisol 0.20 μg/dL (5-25 μg/dL) and ACTH 22 pg/mL (10-60 pg/mL) suggesting partial isolated ACTH deficiency. ACTH stimulation test was done and noted with suboptimal response. Evaluation of other anterior pituitary hormones was normal. Brain MRI showed normal pituitary gland. She was started on hydrocortisone in AM and PM and symptoms resolved. Conclusion: Immediate recognition of isolated ACTH deficiency due to Sheehan’s syndrome is necessary due to the availability of effective treatment and morbidity and mortality associated with this serious condition. To our knowledge isolated ACTH deficiency due to Sheehan’s syndrome in which the patient was able to lactate and normal findings on brain MRI has not previously been reported.References: Shivaprasad C. Sheehan’s Syndrome: Newer advances. Indian J Endocrinol Metab. 2011 Sep; 15(3): S203-207. DOI:10.4103/2230-8210.84869.

scholarly journals HYPOGLYCEMIA AS INITIAL PRESENTATION IN PATIENT WITH ISOLATED ACTH DEFICIENCY

2020 ◽  
Vol 6 (6) ◽  
pp. e338-e341
Author(s):  
Fatimah Mohammed Alabdrabalnabi ◽  
Zahra Abdulwahed AL Saeed ◽  
Yasir Abuelgasim Elamin
Keyword(s):  
Adrenocorticotropic Hormone ◽  
Rare Condition ◽  
Severe Hypoglycemia ◽  
Tolerance Test ◽  
Pituitary Hormones ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Imaging Results ◽  
Life Threatening ◽  
Pituitary Antibodies

Objective: Isolated adrenocorticotropic hormone (ACTH) deficiency is characterized by loss of adrenocorticotropic hormone, resulting in adrenal insufficiency, which can lead to life threatening severe hypoglycemia. We report a case of isolated ACTH deficiency with emphases on presentation, common etiologies, diagnosis, and management. Methods: The clinical course in addition to laboratory and imaging results are presented. These include cortisol level, ACTH, other pituitary hormones, insulin tolerance test, pituitary antibodies, and pituitary magnetic resonance imaging. Results: A 19-year-old male was brought by ambulance to the emergency department with loss of consciousness and a random blood sugar of 30 mg/dL. Our patient had a barely detectable level of plasma ACTH repeatedly and cortisol <1 μg/dL. There was no involvement of other pituitary hormones. Steroid replacement therapy led to resolution of all symptoms and prevented further episodes of hypoglycemia. Conclusion: Isolated ACTH deficiency is a rare condition that is challenging to diagnose and can lead to serious life-threatening problems if unrecognized. Proper management can be achieved with appropriate hydrocortisone supplementation to mimic the normal secretion under both normal conditions and during a state of stress.

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 Acute Sheehan’s Syndrome Associated with Postpartum Hemorrhage

2017 ◽  
Vol 23 (1) ◽  
pp. 65-67
Author(s):  
Deokkyeong Kim ◽  
Jiwon Min ◽  
Yun-Sook Kim ◽  
Aeli Ryu
Keyword(s):  
Postpartum Hemorrhage ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

scholarly journals A Case of Sheehan's Syndrome Associated with Severe Anemia and Empty Sella Proved 48 Years After Postpartum Hemorrhage.

1995 ◽  
Vol 42 (6) ◽  
pp. 803-809 ◽  
Author(s):  
KIMIKO ISHIKAWA ◽  
MOTOI SOHMIYA ◽  
HIROSHI FURUYA ◽  
YUZURU KATO
Keyword(s):  
Postpartum Hemorrhage ◽  
Empty Sella ◽  
Severe Anemia ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

scholarly journals Sheehan’s Syndrome Revisited: Underlying Autoimmunity or Hypoperfusion?

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
José Gerardo González-González ◽  
Omar David Borjas-Almaguer ◽  
Alejandro Salcido-Montenegro ◽  
René Rodríguez-Guajardo ◽  
Anasofia Elizondo-Plazas ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Diagnostic Criteria ◽  
Postpartum Hemorrhage ◽  
Hypovolemic Shock ◽  
Sheehan’S Syndrome ◽  
History Of ◽  
Sheehan's Syndrome ◽  
Pituitary Antibodies

Sheehan’s syndrome remains a frequent obstetric complication with an uncertain pathophysiology. We aimed to assess the incidence of hypopituitarism (≥2 hormonal axis impairment) within the first six postchildbirth months and to determine the existence of anti-pituitary antibodies. From 2015 to 2017, adult pregnant women, who developed moderate to severe postpartum hemorrhage (PPH), were consecutively included in the study. Pituitary function was assessed 4 and 24 weeks after PPH. At the end of the study, anti-pituitary antibodies were assessed. Twenty women completed the study. Mean age was 26.35 (±5.83) years. The main etiology for severe PPH was uterine atony (65%) which resulted mostly in hypovolemic shock grades III-IV. Within the first four weeks after delivery, 95% of patients had at least one hormonal pituitary affected and 60% of the patients fulfilled diagnostic criteria for hypopituitarism. At the end of the study period, five patients (25%) were diagnosed with hypopituitarism (GH and cortisol axes affected). Anti-pituitary antibodies were negative in all patients. At 6 months follow-up, one in every four women with a history of moderate-to-severe PPH was found with asymptomatic nonautoimmune-mediated hypopituitarism. The role of autoimmunity in Sheehan’s syndrome remains uncertain. Further studies are needed to improve the remaining knowledge gaps.

scholarly journals Etiopathogenesis of Sheehan’s Syndrome: Roles of Coagulation Factors and TNF-Alpha

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Halit Diri ◽  
Elif Funda Sener ◽  
Fahri Bayram ◽  
Nazife Tascioglu ◽  
Yasin Simsek ◽  
...  
Keyword(s):  
Gene Polymorphisms ◽  
Venous Blood ◽  
Hormone Deficiency ◽  
Control Group ◽  
Pituitary Hormone ◽  
Factor V ◽  
Sheehan’S Syndrome ◽  
Factor Ii ◽  
Sheehan's Syndrome ◽  
Pai 1

Sheehan’s Syndrome (SS) is defined as pituitary hormone deficiency due to ischemic infarction of the pituitary gland as a result of massive postpartum uterine hemorrhage. Herein, we aimed to investigate the roles ofFactor II(G20210A),Factor V(G1691A),MTHFR(C677T and A1298C),PAI-14G/5G, andTNF-α(-308  G>A) gene polymorphisms in the etiopathogenesis of SS. Venous blood samples were obtained from 53 cases with SS and 43 healthy women. Standard methods were used to extract the genomic DNAs.Factor II(G20210A),Factor V(G1691A), andMTHFR(C677T and A1298C) polymorphisms were identified by real-time PCR.PAI-14G/5G andTNF-α(-308  G>A) gene polymorphisms were detected with polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. According to statistical analysis, none of the polymorphisms were found to be significantly higher in the SS group compared to the control group. Hence, we suggest that genetic factors other thanFactor II, Factor V, MTHFR, PAI-1, andTNF-αgene polymorphisms should be researched in the etiopathogenesis of SS.

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 Adrenal crisis precipitated by influenza A led to the diagnosis of Sheehan's syndrome 18 years after postpartum hemorrhage

2020 ◽  
Vol 8 (12) ◽  
pp. 3082-3087
Author(s):  
Jumpei Taniguchi ◽  
Hitoshi Sugawara ◽  
Hodaka Yamada ◽  
Katsuyuki Yoshida ◽  
Ibuki Kurihara ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Influenza A ◽  
Adrenal Crisis ◽  
Sheehan’S Syndrome ◽  
Sheehan's Syndrome

scholarly journals Severe Hypoglycemia due to Isolated ACTH Deficiency in Children: A New Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Michael Y. Torchinsky ◽  
Robert Wineman ◽  
George W. Moll
Keyword(s):  
Severe Hypoglycemia ◽  
Hormone Deficiency ◽  
Published Data ◽  
Pituitary Hormone ◽  
Review Of The Literature ◽  
Older Children ◽  
Isolated Acth Deficiency ◽  
Acth Deficiency ◽  
Undetectable Plasma ◽  
Before And After

Isolated ACTH deficiency causes life-threatening severe hypoglycemia. A 7-year-old girl with hypoglycemia due to this rare disorder is described. Our patient had undetectable plasma ACTH repeatedly and cortisol 0 mcg/dl before and after ACTH 1-24 stimulation. There was no evidence of other pituitary hormone deficiency. Glucocorticoid replacement therapy resulted in resolution of all symptoms and normalization of blood glucose. Previously published data on isolated ACTH deficiency in children is summarized. Review of the literature showed that the prevalence of this condition could be underestimated in the neonatal period and in Prader-Willi syndrome. Isolated ACTH deficiency occurs in older children as well as in neonates.

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