Autoimmune Hyperthyroidism due to Secondary Adrenal Insufficiency: Resolution with Glucocorticoids |
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| Institution: | 1. From the Geriatric Rehabilitation Department, University Hospital of Parma, Parma, Italy;2. Department of Clinical and Experimental Medicine, Section of Geriatrics, Food Sciences Unit and Endocrinology of Aging Unit, University of Parma, Parma, Italy;3. Hematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milano, Italy;4. Azienda Sanitaria Firenze, Firenze, Italy;5. Department of Geriatrics, Neurosciences and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy;6. National Institute on Aging, National Institutes of Health, Baltimore, Maryland.;1. Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant''Andrea Hospital, Sapienza University of Rome, Italy;2. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy;3. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA;4. Department of Psychiatry, University of Melbourne, The Melbourne Clinic, Melbourne, Australia;5. Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, Australia;1. Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran;2. Department of Radiology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran;3. Department of Pediatric Endocrinology and Metabolism, Mofid Children''s Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran;4. Pediatric Infections Research Center, Research Institute for Children''s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran;5. Pediatric Congenital Hematologic Disorders Research Center, Research Institute for Childern Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran |
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| Abstract: | ObjectiveTo describe the course of autoimmune hyperthyroid disease in a patient with corticotropin (ACTH) deficiency treated with glucocorticoids.MethodsWe report the clinical presentation, laboratory data, imaging studies, and management of a patient with weight loss, fatigue, apathy, hallucinations, and arthritis.ResultsAutoimmune hyperthyroidism (positive thyroperoxidase and thyroglobulin antibodies and borderline positive thyrotropin receptor antibody) was diagnosed in a 71-year-old woman. New psychotic symptoms prompted brain magnetic resonance imaging, which revealed a partially empty sella. Undetectable morning cortisol, undetectable ACTH, and failure to stimulate cortisol with synthetic ACTH (cosyntropin 250 mcg) secured the diagnosis of long-standing secondary adrenal insufficiency. Hydrocortisone replacement improved the patient’s symptoms, resolved the thyroid disease, and decreased thyroid antibody titers. In retrospect, the patient recalled severe postpartum hemorrhage requiring blood transfusion at age 38 years. A Sheehan event probably occurred 33 years before the patient presented with corticotropin deficiency. Hyperthyroidism accelerated cortisol metabolism and provoked symptoms of adrenal insufficiency.ConclusionsThe hypocortisolemic state may precipitate hyperimmunity and autoimmune thyroid disease. Rapid resolution of hyperthyroidism and decreased thyroid antibody titers with glucocorticoid treatment support this hypothesis. (Endocr Pract. 2011;17:85-90) |
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