ACUTE ADRENAL INSUFFICIENCY AFTER UNILATERAL ADRENALECTOMY IN CUSHINGS-SYNDROME - PRECIPITATION BY LITHIUM-INDUCED THYROTOXICOSIS DURING CORTISOL REPLACEMENT

We present a patient with Cushing's syndrome due to adrenocortical ade noma who developed acute adrenal insufficiency one month after unilate ral adrenalectomy. She had received lithium carbonate for five years f or manic-depressive psychosis. Drug administration was interrupted for 2 weeks postoperatively and was resumed thereafter. At the adrenal cr isis, her serum free T-4 and T-3 levels were both high and serum TSH w as subnormal. The thyrotoxicosis subsided spontaneously within 2 weeks . Serum thyroglobulin was markedly increased during the thyrotoxic sta te. Tests for antimicrosomal antibodies and antithyroglobulin antibodi es remained negative. Examination of an open-biopsy specimen of the th yroid gland showed no evidence of thyroiditis. We considered the trans ient thyrotoxicosis to be due to lithium-induced thyrotoxicosis. Cauti on should therefore be exercised in administering lithium carbonate, e specially when the patient's adrenal reserve is low, since even a mild degree of thyrotoxicosis can precipitate an acute adrenal crisis.