A case of isolated ACTH deficiency with primary hypothyroidism after postpartum hemorrhage

Korean J Med > Volume 72(2); 2007 > Article

Original Article

The Korean Journal of Medicine 2007;72(2):230-234.

A case of isolated ACTH deficiency with primary hypothyroidism after postpartum hemorrhage

고려대학교 의과대학 내과학교실

증례 : 산후 출혈 이후 발생한 원발성 갑상선 기능 저하증을 동반한 부신 피질 자극 호르몬 단독 결핍 1예

하직환

Abstract

Isolated ACTH deficiency is a rare cause of secondary adrenal insufficiency. The diagnosis of isolated ACTH deficiency is made by demonstrating low cortical production together with a low plasma ACTH level, the absence of adrenal responses to stimulation by the pituitary and hypothalamus with an intact adrenal response to exogenous ACTH, and normal secretory indices of the other pituitary hormones. A 29 years old female patient with complaints of progressive headache of the occipital area and fatigue after postpartum hemorrhage was admitted for evaluation of her pituitary function. She showed low levels of plasma ACTH and cortisol. On the combined pituitary stimulating test, the adrenocortical response was decreased and the TSH response was increased. The adrenocortical function showed a decreased response to the CRH stimulation test, but an intact response to the rapid ACTH stimulation test. Through thyroid evaluation, primary hypothyroidism was found with weakly positive microsomal Ab. We report here on a case of isolated ACTH deficiency combined with primary hypothyroidism after postpartum hemorrhage.(Korean J Med 72:S230-S234, 2007) Key Words : Adrenal insufficiency, ACTH, Hypothyroidism, Postpartum hemorrhage

Key Words: Adrenal insufficiency, ACTH, Hypothyroidism, Postpartum hemorrhage