A Case of Congenital Hypopituitarism: Difficulty in the Diagnosis of ACTH Deficiency Due to High Serum Cortisol Levels from a Hypothyroid State.
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Accession number;99A0439797
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| Title;A Case of Congenital Hypopituitarism: Difficulty in the Diagnosis of ACTH Deficiency Due to High Serum Cortisol Levels from a Hypothyroid State. |
| Author;
NANAO K
(Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Jpn)
MIYAMOTO J
(Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Jpn)
ANZO M
(Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Jpn)
TSUKUDA T
(Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Jpn)
HASEGAWA Y
(Tokyo Metropolitan Kiyose Children's Hospital, Tokyo, Jpn)
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Journal Title;Endocr J
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Journal Code:F0625A
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ISSN:0918-8959
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VOL.46;NO.1;PAGE.183-186(1999)
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| Figure&Table&Reference;TBL.3, REF.7 |
| Pub. Country;Japan |
| Language;English |
| Abstract;A three-month-old boy presented congenital hypopituitarism in which the hypothyroid state masked ACTH deficiency. Multiple anterior pituitary hormone deficiencies, including ACTH, were finally confirmed. High basal serum cortisol levels(up to 45.1.MU.g/dl) were observed during a stressful episode before L-thyroxine replacement therapy was started. Decreased morning serum cortisol levels(5.0.MU.g/dl or below) were observed on the sixth day of L-thyroxine replacement therapy despite mild hypoglycemia(lowest serum glucose level of 50mg/dl). ACTH deficiency was then confirmed by insulin-induced hypoglycemia test (peak serum cortisol level of 4.9.MU.g/dl). The present findings showed that serum cortisol levels can be high during a stressful episode in an infant with ATCH dificiency and a coexisting hypothyroid state. Thus, the diagnostic evaluation of adrenal function soon after L-thyroxine replacement therapy is important in order to verify a possible subclinical ACTH deficiency, even in the presence of high serum cortisol levels before L-thyroxine replacement therapy. (author abst.) |
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