Corticotroph deficiency is a crucial element of anterior pituitary failure requiring careful management. Clinicians should always look for corticotroph deficiency in patients with pituitary disease and also consider the diagnosis in patients with unexplained fatigue, especially when associated with weight loss and/or hypotension. The diagnosis is based on the morning (8 a.m.) serum cortisol level, generally completed with a stimulation test, keeping in mind its poor sensitivity. Metopirone or insulin tolerance tests may be needed. Treatment is based on administration of hydrocortisone at the daily dose of about 20mg, fractionated into two or three doses if possible. There are no reliable biological parameters for monitoring therapeutic efficacy. Treatment is adapted as a function of clinical criteria: fatigue, blood pressure, body weight, and skin trophicity. Therapeutic education is a key element for the prevention of acute adrenal failure, which can occur if the treatment is not correctly adapted during episodes of gastrointestinal disease or stress.
Copyright © 2012. Published by Elsevier Masson SAS.