Iwamura Shogo, Watts Shiori, Sakuraba Kazuma, Yamamoto Yohei, Matsuda Daisuke
Division of Diabetes and Endocrinology, Nakadori General Hospital, Akita, JPN.
Division of Neurology, Nakadori General Hospital, Akita, JPN.
Cureus. 2024 Aug 5;16(8):e66217. doi: 10.7759/cureus.66217. eCollection 2024 Aug.
Isolated adrenocorticotropic hormone deficiency (IAD) is a rare pituitary disorder that can cause adrenal insufficiency. However, due to its nonspecific symptoms, its diagnosis is often difficult and may be delayed. Patients with IAD require lifelong glucocorticoid (GC) replacement therapy. Contrastingly, GC-induced secondary adrenal insufficiency is a reversible condition that arises when patients receiving GC therapy reduce their GC dosage or discontinue therapy. Differentiating between IAD and GC-induced secondary adrenal insufficiency is clinically crucial. We report a unique case that required differentiation between these two conditions. A 71-year-old Japanese woman presented with symptoms of adrenal insufficiency after discontinuation of GC therapy for eosinophilic esophagitis. We conducted detailed interviews and repeated the endocrinological examinations. We concluded that her symptoms were owing to IAD rather than GC-induced secondary adrenal insufficiency. She began a lifelong hydrocortisone replacement therapy. This case suggests that when caring for patients undergoing GC therapy, it is important to consider the possibility of coexisting IAD and arrange endocrinological examinations if signs of adrenal insufficiency arise during the gradual reduction of GC treatment.
孤立性促肾上腺皮质激素缺乏症（IAD）是一种罕见的垂体疾病，可导致肾上腺功能不全。然而，由于其症状不具特异性，其诊断往往困难且可能延迟。IAD患者需要终身糖皮质激素（GC）替代治疗。相比之下，GC诱导的继发性肾上腺功能不全是一种可逆性疾病，发生在接受GC治疗的患者减少GC剂量或停止治疗时。在临床上区分IAD和GC诱导的继发性肾上腺功能不全至关重要。我们报告了一例需要区分这两种情况的独特病例。一名71岁的日本女性在因嗜酸性食管炎停止GC治疗后出现肾上腺功能不全症状。我们进行了详细的访谈并重复了内分泌检查。我们得出结论，她的症状是由于IAD而非GC诱导的继发性肾上腺功能不全所致。她开始了终身氢化可的松替代治疗。该病例表明，在护理接受GC治疗的患者时，重要的是要考虑并存IAD的可能性，并在GC治疗逐渐减少期间出现肾上腺功能不全迹象时安排内分泌检查。
