scholarly journals Isolated Adrenocorticotropic Hormone Deficiency Accompanied by Impaired Cognitive Function: A Case Report

2021 ◽  
Author(s):  
ATSUKO IKENOUCHI ◽  
Issei Seki ◽  
Naomichi Okamoto ◽  
Yuki Konishi ◽  
Reiji Yoshimura
Keyword(s):  
Cognitive Functions ◽  
Adrenocorticotropic Hormone ◽  
Psychiatric Symptoms ◽  
Hormone Replacement ◽  
Adjustment Disorder ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Physical Treatment

Abstract Background: Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is an adrenal insufficiency caused by a decrease in ACTH alone among the anterior pituitary hormones. IAD is often overlooked because it causes nonspecific symptoms. We report a case of IAD diagnosed after the appearance of mild cognitive impairment (MCI).Case presentation: Our department was consulted on a case of a 46-year-old man for whom dementia was suspected because he was speaking incoherently, wiped his nose with his hands and showed mild brain atrophy on MRI. He was previously diagnosed with some psychiatric diseases, such as narcolepsy and adjustment disorder. He could not continue working due to somnolence, general fatigue and appetite loss. At the examination, he had difficulty concentrating and sustaining attention, exhibited restlessness, and scored 25 points on the Mini Mental State Examination-Japanese (MMSE-J); MCI was observed. Blood tests showed decreased ACTH, cortisol and free thyroxine and increased thyroid-stimulating hormone levels. He received further evaluation, and he was diagnosed with IAD and primary hypothyroidism. Hydrocortisone (15 mg) was started, after which his physical problems and his difficulty concentrating disappeared. His MMSE-J score also increased to 30. His cognitive functions completely recovered. He returned to work and continued to work stably.Conclusion: This patient was diagnosed with IAD and treated with adrenocortical hormone replacement therapy. His cognitive functions recovered, his physical and mental disorders were alleviated, and he returned to society. It is important not to miss neurological and psychiatric symptoms that can be cured by physical treatment.

SERUM PROLACTIN IN PATIENTS WITH "FUNCTIONLESS" CHROMOPHOBE ADENOMAS BEFORE AND AFTER THERAPY

1977 ◽  
Vol 84 (3) ◽  
pp. 449-460 ◽  
Author(s):  
N. A. Samaan ◽  
M. E. Leavens ◽  
J. H. Jesse
Keyword(s):  
Hormone Replacement ◽  
Pituitary Surgery ◽  
Pituitary Tumour ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
High Serum ◽  
Primary Hypothyroidism ◽  
Pituitary Function ◽  
Serum Prolactin ◽  
Before And After

ABSTRACT The immunoreactive serum human prolactin (PRL) level was measured before and after intravenous administration of 500 μg of thyrotrophinreleasing hormone (TRH) in 11 patients with "functionless" chromophobe adenomas before and after surgery and after radiotherapy in 6 of these patients. The results were compared to other pituitary function tests. Two of the patients studied had recurrent disease after previous pituitary surgery and radiotherapy. Five patients had pituitary surgery through the transfrontal route, while 6 had adenoma removal via the transnasal transsphenoidal route. Before surgery, the serum PRL concentration was abnormally high in 4 patients, before and after TRH administration. It was normal in 6 and subnormal in 1 patient who had had previous therapy. Two of the patients studied showed high serum thyroid-stimulating hormone (TSH) levels in the presence of low serum T3 and T4 suggesting primary hypothyroidism with a secondary TSH-producing pituitary tumour. After surgery all patients showed a significant decrease of the serum PRL level. This contrasts with more variable results in the measurements of other pituitary hormones. Post-operative radiotherapy produced no significant additional change in serum PRL levels in 5 of the 6 patients measured 6 months to 4 years after radiotherapy. Five of the 6 patients who had adenoma removed via the transsphenoidal route required no cortisol replacement and 4 remained euthyroid, whereas all 5 patients after transfrontal surgery required both cortisol and thyroid hormone replacement. These results indicate: (1) that measurement of serum PRL levels at basal and after TRH administration in patients with "functionless" chromophobe adenomas before and after treatment may be the best index for evaluating the effect of therapy; (2) that adenoma removal may be followed by preservation of normal pituitary function, but this is more likely to occur if the transsphenoidal approach is used; and (3) that primary thyroid insufficiency may be associated with a pituitary adenoma.

scholarly journals Hypothyroidism: current state of the problem

2020 ◽  
pp. 96-107
Author(s):  
E. V. Biryukova ◽  
D. V. Kileynikov ◽  
I. V. Solovyeva
Keyword(s):  
Kinase Inhibitors ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Thyroid Stimulating Hormone ◽  
Pathological Process ◽  
Primary Hypothyroidism ◽  
The Body ◽  
Hormone Deficiency ◽  
Side Reactions ◽  
Secondary Hypothyroidism

The article presents the issues of epidemiology, classification, and clinic of hypothyroidism. The frequency of hypothyroidism increases significantly with age. The most common form is primary hypothyroidism, caused by a pathological process in the thyroid gland itself. Secondary hypothyroidism or tertiary hypothyroidism is caused by insufficient secretion of thyroid- stimulating hormone (TSH), or thyrotropin-releasing hormone. The article deals with the main causes of primary and secondary hypothyroidism. The most common cause of primary hypothyroidism is autoimmune thyroiditis, which can develop both separately and simultaneously with other autoimmune diseases, as part of polyglandular syndrome. Special attention should be paid to the change of thyroid status as a result of adverse side reactions when using a range of drugs. The questions about the mechanisms of thyroid insufficiency development as a result of unfavorable side reactions when using a number of drugs (lithium preparations, iodine-containing compounds, tyrosine kinase inhibitors, etc.) have been raised. Undiagnosed hypothyroidism is a risk factor for the progression of already existing cardiovascular diseases. The severity of clinical manifestations is determined by the severity of thyroid hormone deficiency. There are no significant clinical differences between the pronounced forms of primary and secondary hypothyroidism. Depending on the degree of lesion, secondary hypothyroidism may be complicated by other manifestations of hypothalamic-pituitary disorders, as well as the latter may include a decrease in the secretion of antidiuretic hormone at a certain stage of their development. Diagnostic difficulties are discussed, as hypothyroidism disrupts the functioning of most organs and systems of the body (musculoskeletal, cardiovascular, urinary, gastrointestinal, central and peripheral nervous systems) and can be masked by various diseases. The final diagnosis of hypothyroidism is clarified by a number of laboratory and instrumental studies. Substitution therapy with levothyroxine is used to treat hypothyroidism of any etiology.

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.

The pituitary and hypopituitarism

2020 ◽  
pp. 83-120
Author(s):  
Gary Butler ◽  
Jeremy Kirk
Keyword(s):  
Anterior Pituitary ◽  
Pituitary Hormones ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Sexual Characteristics ◽  
Biochemical Assessment ◽  
Cranial Diabetes Insipidus ◽  
Clinical Problems ◽  
Stimulating Hormone

• The pituitary is formed of two anatomically and embryologically distinct lobes: ◦ anterior pituitary: which secretes growth hormone (GH), gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH), and prolactin ◦ posterior pituitary: which secretes vasopressin and oxytocin. • Hypopituitarism is deficiency of one or more pituitary hormones. Some hormones, e.g. GH (LH/FSH), are more likely to present with isolated deficiencies, while others, e.g. TSH, ACTH, are more often found as part of multiple pituitary hormone deficiency (MPHD). • Deficiencies may be congenital (including genetic) or acquired; secondary to tumour, trauma, infiltration, infection, or irradiation. • GH deficiency: ◦ diagnosed using a combination of clinical, radiological, and biochemical assessment (including GH stimulation testing) ◦ treatment is with GH (including if necessary into adulthood). • LH/FSH deficiency: ◦ If acquired, often one of the first anterior pituitary hormones to be lost. ◦ Congenital forms: ■ present with cryptorchidism and/or micropenis in males ■ may occur in isolation, or in association with anosmia (Kallmann and CHARGE syndromes). ◦ Treatment: sex steroid therapy to induce secondary sexual characteristics, and recombinant FSH/LH to induce fertility potential. • ACTH deficiency: ◦ Unlike primary adrenal problems, hyperpigmentation does not occur. ◦ Although mineralocorticoid production is preserved, hyponatraemia may still occur. ◦ Treatment is with hydrocortisone. • TSH deficiency: ◦ TSH may be low, normal, or raised (but inappropriate for free thyroxine level). ◦ Treatment is with thyroxine. • Vasopressin deficiency: ◦ produces cranial diabetes insipidus ◦ treatment is with DDAVP (orally or nasally). • Prolactin and oxytocin deficiency rarely produce clinical problems.

Hypopituitarism: replacement of adrenal, thyroid, and gonadal axes

2011 ◽  
pp. 145-152 ◽  
Author(s):  
Trevor A. Howlett
Keyword(s):  
Anterior Pituitary ◽  
Patient Management ◽  
Hormone Replacement ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Pituitary Hormone ◽  
Best Management ◽  
Anterior Pituitary Hormone ◽  
The Subject ◽  
Based Medicine

Hormone replacement of anterior pituitary hormone deficiency is one of the most frequent clinical interventions in pituitary disease, yet is an area which has rarely been the subject of rigorous scientific evaluation. Even in an era of ‘evidence-based’ medicine, recommendations for patient management are frequently based predominantly on clinical experience, consensus guidelines and occasional retrospective reviews rather than on controlled, prospective clinical trials. Within these limitations, this chapter will attempt to give a balanced view on current best management of adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone (TSH) and gonadotropin deficiency.

Efficacy and safety of Barg-e-Sahajna (Moringa olifera Lam.) in primary hypothyroidism

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Md Anzar Alam ◽  
Mohd Aleemuddin Quamri ◽  
Nafis Haider
Keyword(s):  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Hormone Deficiency ◽  
Efficacy And Safety ◽  
Serum Glutamic Oxaloacetic Transaminase ◽  
Objective Parameter ◽  
Serum T3 ◽  
Safety Parameters ◽  
Serum Tsh

Abstract Objectives Hypothyroidism is the most common disorder arising from hormone deficiency. It frequently affects women than men. The prevalence of overall hypothyroidism has been reported to be 4.8–11%. Levothyroxine is the treatment of choice for all types of hypothyroidism. The purpose of this pilot study was to evaluate the efficacy and safety of Barg-e-Sahajna (Leaves of Moringa olifera Lam.) among diagnosed patients of primary hypothyroidism. Methods This study was an open observational study. A total of 22 patients were screened, out of which 10 were excluded (did not meet inclusion criteria) and 2 refused to consent to be part of the study, rest 10 participants were enrolled after obtaining written informed consent finally 8 subjects completed the study and 2 are dropout in last follow up. The drug was given in the form of decoction at the dose of 5 g fresh leaves twice a day after meal for 45 days. Results The study effects on objective parameter thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were found extremely significant when compared before (16.62 ± 11.49, 132 ± 19.32, 9.28 ± 1.46) and after (4.75 ± 3.12, 150.37 ± 20.68, 11.84 ± 3.81) treatment with a significant decrease in serum TSH level (p<0.0246) and an increase in serum T3 (p<0.0005) and T4 (p<0.0438) levels. The results were analyzed using paired “t” test. Conclusions The improvements in thyroid profiles (TSH, T3 and T4) after consuming ‘Barg-e-Sahajna’ show that the test drug is effective in primary hypothyroidism and the relief was considerable. No significant effect on safety parameters (serum-glutamic-oxaloacetic-transaminase [SGOT], serum glutamic-pyruvic transaminase [SGPT], blood urea, and serum creatinine) was observed. Therefore, it may be concluded that the Barg-e-Sahajna is preliminarily safe and effective in the management of primary hypothyroidism.

scholarly journals Isolated Adrenocorticotropic Hormone Deficiency Caused by Camrelizumab in a Patient with Lung Sarcoma: A Case Report and Literature Review

2021 ◽  
Author(s):  
Wen Huang ◽  
Saran Feng
Keyword(s):  
Immune Checkpoint ◽  
Adrenocorticotropic Hormone ◽  
Late Onset ◽  
Malignant Tumors ◽  
Checkpoint Inhibitors ◽  
Endocrine System ◽  
Pituitary Hormones ◽  
Endocrine Function ◽  
Hormone Deficiency ◽  
Multiple Organs

Abstract Background Immune checkpoint inhibitors significantly increase survival in some malignant tumors, but they also lead to a variety of immune-related adverse events that affect multiple organs, including the liver, lung and endocrine system. Isolated adrenocorticotropic hormone (ACTH) deficiency (IAD) is a rare pituitary disorder characterized by secondary adrenal insufficiency with low or absent cortisol production but the normal secretion of pituitary hormones other than ACTH. IAD caused by atezolizumab, pembrolizumab and nivolumab therapy had been reported, but none is reported in camrelizumab, a new immune checkpoint inhibitor (ICI). Clinicians may not be aware of this unusual side effect. Case presentation: Here, we describe a 70-year-old male patient who had lung sarcoma and was treated with camrelizumab. After nine months of treatment, he developed immune-related pneumonia and hepatitis associated with camrelizumab. The patient discontinued the drug and recovered soon after administration of glucocorticoids. But he subsequently appeared severe hyponatremia, and was diagnosed with late-onset IAD induced by camrelizumab. His symptoms alleviated after glucocorticoid replacement therapy. Conclusion Regular monitoring serum sodium levels and testing endocrine function should be beneficial for cancer patients not only during the treatment of camrelizumab but also after discontinuation of the ICI. Clinicians should consider IAD induced by ICIs when hyponatremia occurs in the patients.

scholarly journals Management of Hypopituitarism

2019 ◽  
Vol 8 (12) ◽  
pp. 2153 ◽  
Author(s):  
Krystallenia Alexandraki ◽  
Ashley Grossman
Keyword(s):  
Replacement Therapy ◽  
Hormone Replacement ◽  
Clinical Signs ◽  
Immediate Release ◽  
Thyroid Stimulating Hormone ◽  
Hormone Deficiency ◽  
Adrenal Crisis ◽  
Endocrine Gland ◽  
Posterior Lobe ◽  
Clinical Scenarios

Hypopituitarism includes all clinical conditions that result in partial or complete failure of the anterior and posterior lobe of the pituitary gland’s ability to secrete hormones. The aim of management is usually to replace the target-hormone of hypothalamo-pituitary-endocrine gland axis with the exceptions of secondary hypogonadism when fertility is required, and growth hormone deficiency (GHD), and to safely minimise both symptoms and clinical signs. Adrenocorticotropic hormone deficiency replacement is best performed with the immediate-release oral glucocorticoid hydrocortisone (HC) in 2–3 divided doses. However, novel once-daily modified-release HC targets a more physiological exposure of glucocorticoids. GHD is treated currently with daily subcutaneous GH, but current research is focusing on the development of once-weekly administration of recombinant GH. Hypogonadism is targeted with testosterone replacement in men and on estrogen replacement therapy in women; when fertility is wanted, replacement targets secondary or tertiary levels of hormonal settings. Thyroid-stimulating hormone replacement therapy follows the rules of primary thyroid gland failure with L-thyroxine replacement. Central diabetes insipidus is nowadays replaced by desmopressin. Certain clinical scenarios may have to be promptly managed to avoid short-term or long-term sequelae such as pregnancy in patients with hypopituitarism, pituitary apoplexy, adrenal crisis, and pituitary metastases.

Recurrent Galactorrhoea: A consequence of unheeded primary hypothyroidism

2021 ◽  
Vol 4 (1) ◽  
pp. 54-59
Author(s):  
Olutomiwa Omokore ◽  
Nwachukwu Nwachukwu ◽  
Oreoluwa Fuwape ◽  
Adetomilayo Arijeniwa ◽  
Abiola Adekoya ◽  
...  
Keyword(s):  
Hormone Replacement ◽  
Elevated Serum ◽  
Signs And Symptoms ◽  
Symptomatic Improvement ◽  
Thyroid Stimulating Hormone ◽  
Pharmacological Therapy ◽  
Primary Hypothyroidism ◽  
Serum Prolactin ◽  
Low Mood ◽  
Hormonal Assay

Background: Primary hypothyroidism can lead to hyperprolactinemia through several mechanisms in both men and women, manifesting as galactorrhoea, loss of libido, and infertility in both sexes, as oligomenorrhea/amenorrhea in women, and as gynecomastia and erectile dysfunction in men. Case presentation: Here presented is a 28-year-old Nigerian woman with a history of recurrent bilateral painless galactorrhoea of 12 years’ duration and persistent low mood. Physical examination was unremarkable. The hormonal assay revealed elevated thyroid-stimulating hormone, elevated serum prolactin, low thyroxine, and low triiodothyronine levels. Magnetic resonance imaging of the brain revealed normal findings. A diagnosis of hyperprolactinemia secondary to primary hypothyroidism was made. Pharmacological therapy began with thyroid hormone replacement therapy and a dopamine agonist: 75 micrograms of levothyroxine daily and 0.5 micrograms of cabergoline twice weekly for 8 weeks. After 8 weeks of pharmacological therapy, hormonal assay revealed values within the reference range with significant symptomatic improvement evidenced by cessation of galactorrhoea and low mood. Conclusion: Primary hypothyroidism has been proven to be one of the numerous causes of hyperprolactinemia and it could be unheeded in a patient who does not present with the typical signs and symptoms of primary hypothyroidism.

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