ＡＣＴＨ単独欠損症による下垂体性昏睡の１例

DOI 被引用文献1件 参考文献9件

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  • Pituitary coma as a consequence of an unrecognized isolated ACTH deficiency.

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An isolated ACTH deficiency is a rare cause of pituitary coma, which is a life-threatening complication of hypopituitarism. We report a 77-year-old woman with an unrecognized isolated ACTH deficiency who had a hypopituitary crisis with coma and severe hypotension provoked by pneumonia. In October 1996, the patient complained of anorexia and fatigue, which could not be improved except by specific treatment. On 11 November, she was admitted to our ICU with coma, severe hypotension, respiratory insufficiency and anuria. Initially we suspected septic shock and septic encephalopathy, but endocrinological examinations which were performed for differential diagnosis revealed that she had an unrecognized isolated ACTH deficiency. She regained consciousness within 48 hours after intravenous replacement of hydrocortisone. These findings suggest that glucocorticoid may be directly involved in the control of consciousness, and that waiting for laboratory confirmation of a diagnosis must not delay immediate life-saving hydrocortisone replacement.

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