ISOLATED ADRENOCORTICOTROPIC HORMONE DEFICIENCY ASSOCIATED WITH GROWTH-HORMONE DEFICIENCY AND EMPTY SELLA

A 38-year-old man had an acute onset of consciousness loss, pyrexia an d hyponatremia, Plasma Adrenocorticotropic Hormone (ACTH) and cortisol levels were low, Plasma ACTH failed to respond to corticotropin-relea sing hormone (CRH) and insulin-induced hypoglycemia whereas i.m. injec tion of ACTH-Z raised plasma cortisol, Plasma insulin-like growth fact or-I (IGF-I) and urine growth hormone (GH) concentrations were also lo w and plasma thyroid-stimulating hormone (TSH) level was father elevat ed, Plasma IGF-I and TSH levels were not completely normalized by gluc ocorticoid (GC) replacement alone although plasma GH responses to phar macological stimuli were normalized, The GC replacement in combination with daily s.c. injection of recombinant human GH (rhGH) not only nor malized plasma IGF-I and IGFBP-3 levels, but also further lowered the plasma TSH level, possibly due to an increased T-4/T-3 conversion, whi ch resulted in a beneficial change in body composition.