Isoda Atsushi, Saito Akio, Matsumoto Morio, Sawamura Morio
Department of Hematology, Iryo Hojin Hoshi Iin, Maebashi, Japan
Department of Hematology, NHO Shibukawa Medical Center, Shibukawa, Japan.
BMJ Case Rep. 2023 Oct 10;16(10):e256049. doi: 10.1136/bcr-2023-256049.
Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder but not a known cause of hyperferritinaemia. We here report a man with IAD who presented with mild anaemia and unexpected hyperferritinaemia (serum ferritin, 1796 µg/L). He had high serum hepcidin and relatively low erythropoietin levels for his anaemia, with hepcidin and ferritin levels reducing with hydrocortisone supplementation. We speculate that low glucocorticoid levels might suppress erythropoiesis and anti-inflammatory activity, resulting in a higher hepcidin level and hyperferritinaemia. The possibility of adrenal insufficiency including IAD should be considered as a differential diagnosis in patients with unexplained hyperferritinaemia.
孤立性促肾上腺皮质激素缺乏症（IAD）是一种罕见疾病，但并非已知的高铁蛋白血症病因。我们在此报告一名患有IAD的男性，他表现为轻度贫血和意外的高铁蛋白血症（血清铁蛋白，1796µg/L）。对于他的贫血，其血清铁调素水平较高且促红细胞生成素水平相对较低，补充氢化可的松后铁调素和铁蛋白水平降低。我们推测低糖皮质激素水平可能会抑制红细胞生成和抗炎活性，导致铁调素水平升高和高铁蛋白血症。对于不明原因高铁蛋白血症的患者，应考虑包括IAD在内的肾上腺功能不全的可能性作为鉴别诊断。
