Isolated ACTH Deficiency Latent Nature in Adults

The diagnosis of isolated corticotrophin (ACTH) deficiency (IAD) has been facilitated by improved hormone assays and dynamic testing. In the many reports of adults with IAD, most of the signs and symptoms were nonspecific. This study set out to find a clinical characteristic of IAD that would be helpful in planning endocrine studies. Nineteen patients with IAD, 15 men and 4 women were studied. There were no abnormalities outside the anterior pituitary. Serum cortisol levels were not raised after ACTH releasing hormone administration. Five other anterior pituitary hormones were normal. Serum cortisol levels or urinary 17-OHCS excretion were increased by ACTH injection in most of them. Only one sought medical help for chronic nonspecific signs and symptoms per se. The other 18 patients sought medical help for inability to eat, prostration with hypovolemia, hyponatremia, or hypoglycemia after an acute illness. Three were admitted in adrenal crisis. There was nothing in the history and physical examination that would suggest chronic adrenal insufficiency.