Abstract
We present a case of fatal adrenal crisis due to isolated adrenocorticotropic hormone (ACTH) deficiency. Autopsy revealed each adrenal gland weighed 0.9 g and the adrenal cortexes were very thin and atrophic. Additionally, cortisol could not be observed in the adrenal cortex by immunohistochemical staining. Furthermore, urine cortisol and 17-OHCS concentration had decreased to a very low level, 20 mg/L and 0.8 mg/L respectively. The anterior pituitary gland was atrophic, and showed fibrosis and lymphocytosis was suspected. Immunohistochemically growth hormone (GH)-stained pituitary gland cells were observed, but there were no cells stained with anti-ACTH antibody. From the history and pathological findings, no other deficiencies of pituitary hormones were evident. Therefore, isolated ACTH deficiency was suspected. Furthermore, as the thyroid gland showed lymphocytic thyroiditis, is was considered that isolated ACTH deficiency was associated with an autoimmune cause. Generally, as patients of chronic adrenocortical insufficiency are exposed to stress and, therefore, have an increased requirement for glucocorticoids, the blood pressure falls, leading to hypovolemic shock called " an adrenal crisis." Without treatment, patients di...Continue Reading
References
Jul 1, 1976·Acta Endocrinologica·T YamamotoY Hirata
Jun 1, 1985·Clinical Endocrinology·W P StephensJ E Adams
Aug 1, 1986·Annals of Internal Medicine·M D JensenP M Banks
Jan 1, 1982·The Journal of Clinical Endocrinology and Metabolism·I KojimaE Ogata
Aug 1, 1993·Endocrine Journal·T MurakamiN Nagata
Feb 1, 1994·Journal of Endocrinological Investigation·H Escobar-MorrealeC Varela
Jun 1, 1993·The American Journal of Forensic Medicine and Pathology·J I Coe
Apr 1, 1962·The Journal of Pathology and Bacteriology·R B GOUDIE, P H PINKERTON
Citations
Oct 11, 2011·International Journal of Legal Medicine·Cristian Palmiere, Patrice Mangin
Oct 19, 2000·Lancet·E A BeckersM C Weijmer
Mar 3, 2009·Internal Medicine·Chizuko UkitaToshiji Iwasaka
Mar 16, 2006·The Journal of Medical Investigation : JMI·Shin-Ichi KuboOsamu Kitamura
Jun 26, 2003·Medical and Pediatric Oncology·Shinsaku ImashukuShinjiro Todo
Sep 13, 2019·Endocrine Reviews·Masaaki YamamotoYutaka Takahashi
Dec 22, 2017·Clinical Endocrinology·Anne Marie HannonUNKNOWN Irish Pituitary Database Group
Mar 29, 2014·Journal of Forensic Sciences·Cristian PalmiereJohannes A Lobrinus
Oct 18, 2019·Journal of the Endocrine Society·Keitaro KanieYutaka Takahashi
Jan 6, 2001·Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists·A M Connell, U M Kabadi
Sep 4, 2003·Journal of Endocrinological Investigation·T MoriY Kato
Apr 20, 1999·The American Journal of Forensic Medicine and Pathology·M P Burke, K Opeskin
Jul 17, 2018·Pituitary·Hironori BandoYutaka Takahashi
Mar 9, 2021·Frontiers in Endocrinology·Yasunori FujitaYutaka Takahashi
May 21, 2021·Journal for Immunotherapy of Cancer·Tomoko KobayashiHiroshi Arima