Roosens B, Maes E, Van Steirteghem A, Vanhaelst L
J Endocrinol Invest. 1982 Jul-Aug;5(4):251-4. doi: 10.1007/BF03348331.
A 50 year old man is described in whom primary hypothyroidism and isolated ACTH deficiency leading to adrenocortical insufficiency occurred simultaneously. Low thyroid hormone levels, elevated serum TSH values and high titers of antithyroid antibodies (ATA) were consistent with primary hypothyroidism. The diagnosis of secondary adrenocortical insufficiency was based on low cortisol and ACTH morning levels, low urinary steroids, a significant increase of cortisol levels after 0.25 mg tetracosactide iv, an absence of ACTH and cortisol release after insulin-induced hypoglycemia and a similar absence of ACTH and 11-deoxycortisol increase after metyrapone administration. After one year treatment and five days withdrawal of cortisol administration, the insulin-induced hypoglycemia still failed to elicit secretory responses of ACTH and cortisol, despite the normalization of thyroid hormone levels. The etiopathogenesis of these two coexisting endocrine deficiencies is discussed.
本文描述了一名50岁男性，其原发性甲状腺功能减退症与导致肾上腺皮质功能不全的孤立性促肾上腺皮质激素（ACTH）缺乏症同时发生。甲状腺激素水平降低、血清促甲状腺激素（TSH）值升高以及抗甲状腺抗体（ATA）高滴度与原发性甲状腺功能减退症相符。继发性肾上腺皮质功能不全的诊断依据为：早晨皮质醇和ACTH水平低、尿类固醇水平低、静脉注射0.25mg替可克肽后皮质醇水平显著升高、胰岛素诱导的低血糖后ACTH和皮质醇无释放以及甲吡酮给药后ACTH和11-脱氧皮质醇无类似升高。经过一年治疗并停用皮质醇五天后，尽管甲状腺激素水平已恢复正常，但胰岛素诱导的低血糖仍未能引发ACTH和皮质醇的分泌反应。本文讨论了这两种并存的内分泌缺陷的病因。
