Two cases of traumatic isolated ACTH deficiency

Tatsuo Ishizuka*, Motochika Asano, Kei Fujioka, Ichiro Mori, Kazuo Kajita and Hiroyuki Morita

Case 1: A 65- year-old man was accidentally injured by wooden hammer on his top of head on 34 years before. He was suffered from vomiting, diarrhea and hypotension, and the laboratory examination revealed increased CRP level, hyponatremia and decreased plasma cortisol and ACTH levels, suggesting isolated ACTH deficiency and Crohn disease diagnosed by colonoscopic biopsy, and finally transferred to University Hospital. LH-RH, TRH, CRH and GHRP stimulation tests showed normal response of plasma pituitary hormones except for no response of plasma ACTH and cortisol levels by CRH stimulation. ACTH stimulation test showed no response of plasma cortisol levels although hydrocotisone replacement therapy had already been started. MRI imaging showed bottom of anterior lobe was crushed and pituitary gland was atrophied, which suggested brain might be injured by any strong trauma. 

Case 2: An 83-years old man was injured on brain contusion by staff’s violence in nursing home, and introduce to our hospital to remove brain hematoma on 6 months before. He presented transient loss of consciousness because of hypoglycemia. Laboratory examinations revealed hyponatremia, and low levels of plasma ACTH and cortisol. Endocrinological examination showed normal LH-RH and TRH stimulations tests, basal GH and IGF-1 levels, and no response of plasma ACTH and cortisol levels by CRH stimulation, showing traumatic isolated ACTH deficiency. MRI imaging showed atrophic pituitary gland. These results suggest that traumatic isolated ACTH deficiency may be able to appear for short and long period after brain injury.

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Published on: Oct 30, 2018 Pages: 4-7

Full Text PDF Full Text HTML DOI: 10.17352/ijcem.000030
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