Abstract
A 73-year-old Japanese woman with untreated Graves' hyperthyroidism developed glucocorticoid-induced adrenal insufficiency (AI) after a supraphysiological dose of prednisolone therapy for bronchial asthma. Days later, she had high plasma adrenocorticotropic hormone (ACTH) levels and was expected to recover from glucocorticoid-induced AI. Her plasma ACTH levels remained high over 3 months during a physiological dose of hydrocortisone replacement. However, she suffered a further decrease in her serum cortisol level and was diagnosed with isolated adrenocorticotropin deficiency (IAD), in which bioinactive ACTH likely caused the high ACTH value. IAD should be considered as an unusual disorder associated with Graves' disease, especially in older patients.
MeSH terms
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Adrenal Insufficiency / chemically induced*
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Adrenal Insufficiency / drug therapy
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Adrenal Insufficiency / physiopathology
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Adrenocorticotropic Hormone / blood*
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Adrenocorticotropic Hormone / deficiency*
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Adrenocorticotropic Hormone / drug effects
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Aged
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Anorexia / blood
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Anorexia / drug therapy
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Antithyroid Agents / therapeutic use
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Asthma / drug therapy*
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Endocrine System Diseases / chemically induced*
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Fatigue / blood
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Fatigue / drug therapy
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Female
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Genetic Diseases, Inborn / chemically induced*
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Glucocorticoids / adverse effects*
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Glucocorticoids / therapeutic use
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Graves Disease / complications
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Graves Disease / drug therapy*
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Graves Disease / physiopathology
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Humans
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Hydrocortisone / blood
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Hydrocortisone / therapeutic use*
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Hypoglycemia / chemically induced*
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Prednisolone / adverse effects*
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Prednisolone / therapeutic use
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Treatment Outcome
Substances
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Antithyroid Agents
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Glucocorticoids
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Adrenocorticotropic Hormone
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Prednisolone
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Hydrocortisone
Supplementary concepts
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ACTH Deficiency, Isolated