Isolated adrenocorticotropin deficiency presenting with impaired renin-angiotensin-aldosterone system and suppressed parathyroid hormone-vitamin D axis

Intern Med. 2002 Jul;41(7):561-5. doi: 10.2169/internalmedicine.41.561.

Abstract

We report here a 47-year-old woman with isolated adrenocorticotropin (ACTH) deficiency (IAD). She presented impaired renin-angiotensin-aldosterone (R-A-A) system and suppressed parathyroid hormone (PTH)-vitamin D system. She showed severe hyponatremia due to secondary adrenocortical insufficiency, which was deteriorated by hypoaldosteronism. She also showed hyperphosphatemia and relative hypercalcemia with suppressed PTH-vitamin D axis. Moreover, she showed hypothyroidism, which was thought to be important to maintain normal Ca levels under secondary hypoadrenalism via decrease in bone resorption by T3. Replacement with glucocorticoid completely normalized PTH-vitamin D axis and R-A-A system. Thus, the present case implicates that severe adrenocortical deficiency due to IAD might affect both R-A-A system and PTH-vitamin D axis. These findings suggest that the ACTH-cortisol axis has an important role in mineral metabolism in vivo.

Publication types

  • Case Reports

MeSH terms

  • Adrenocorticotropic Hormone / deficiency*
  • Adrenocorticotropic Hormone / physiology
  • Anti-Inflammatory Agents / therapeutic use
  • Calcium / metabolism
  • Diagnostic Techniques, Endocrine
  • Endocrine System Diseases / complications
  • Endocrine System Diseases / diagnosis*
  • Endocrine System Diseases / drug therapy
  • Endocrine System Diseases / physiopathology
  • Female
  • Humans
  • Hydrocortisone / therapeutic use
  • Hypoaldosteronism / complications
  • Hypoaldosteronism / diagnosis
  • Hypoaldosteronism / drug therapy
  • Hypoaldosteronism / physiopathology
  • Hypoparathyroidism / complications
  • Hypoparathyroidism / diagnosis
  • Hypoparathyroidism / drug therapy
  • Hypoparathyroidism / physiopathology*
  • Hypopituitarism / complications
  • Hypopituitarism / diagnosis*
  • Hypopituitarism / drug therapy
  • Hypopituitarism / physiopathology*
  • Hypothyroidism / complications
  • Hypothyroidism / physiopathology
  • Middle Aged
  • Renin-Angiotensin System / drug effects
  • Renin-Angiotensin System / physiology*
  • Sodium / metabolism
  • Vitamin D Deficiency / complications
  • Vitamin D Deficiency / diagnosis
  • Vitamin D Deficiency / drug therapy
  • Vitamin D Deficiency / physiopathology*

Substances

  • Anti-Inflammatory Agents
  • Adrenocorticotropic Hormone
  • Sodium
  • Calcium
  • Hydrocortisone