VARIANT ANGINA IN ISOLATED ADRENOCORTICOTROPIN DEFICIENCY, INAPPROPRIATE VASOPRESSIN SECRETION AND HASHIMOTOS-THYROIDITIS

We report a 62-year-old male patient who had variant angina and isolat ed adrenocorticotropic hormone (ACTH) deficiency. Mis serum sodium con centration was low and vasopressin was inappropriately high for the lo w plasma osmolality. Serum free thyroxine (FT4) was low and thyroid st imulating hormone (TSH) was high with positive anti-thyroperoxidase an tibodies, compatible with Hashimoto's thyroiditis. Treatment with Amro dipine and hydrocortisone relieved chest symptoms and hyponatremia, an d hypothyroidism was also normalized. It is suggested that coronary ar tery spasm may be related to cortisol deficiency and/or inappropriatel y high vasopressin secretion and that hypothyroidism was ameliorated b ecause the reduced responsiveness to TSH returned to normal due to hyd rocortisone supplement.