Isolated corticotropin deficiency in chronic alcoholism

Three patients who chronically abused alcohol were found to be hyponatraemi c with normal plasma potassium. The first had been admitted with confusion and weight loss, the second with hypotension and sepsis, and the third with confusion and hypoglycaemia-induced seizures. AII three patients had a sub normal cortisol response in the short synacthen test; however, the plasma c ortisol after three days of tetracosactrin administration was greater than 550 nmol/L. Baseline corticotropin levels were less than 10 pg/mL in all th ree. No structural lesions of the hypothalamo-pituitary tract were found an d there was no evidence of other endocrinopathies. Glucocorticoid replaceme nt therapy led to the resolution of hyponatraemia and hypoglycaemia, where present, and to clinical improvement. The two surviving patients remained h ypocortisolaemic in the long term, without recurrence of hyponatraemia or h ypoglycaemia. The features of isolated corticotropin deficiency are easily confused with other effects of chronic alcohol abuse. In alcoholic patients with unexplai ned hyponatraemia, hypoglycaemia or haemodynamic instability, a short tetra cosactrin test is advisable.