Isolated ACTH deficiency in self referred patients for LOH syndrome: two case reports
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CASE REPORT
Isolated ACTH deficiency in self referred patients for LOH syndrome: two case reports Yoshikazu Sato • Hitoshi Tanda • Hisao Nakajima • Toshikazu Nitta Keigo Akagashi • Tatsuo Hanzawa • Musashi Tobe • Kazunori Haga Kousuke Uchida • Ichiya Honma
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Received: 5 January 2012 / Accepted: 14 February 2012 / Published online: 26 February 2012 Ó Japan Society for Reproductive Medicine 2012
Abstract We experienced two cases of isolated ACTH deficiency (IAD) in patients self referred for late-onset hypogonadism (LOH) syndrome. IAD is secondary adrenal insufficiency due to lack of secretion of ACTH and delayed diagnosis of this rare condition may be life-threatening. The predominant symptoms of IAD, such as general malaise and weakness, resemble those of LOH syndrome creating the possibility that IAD may be referred as LOH syndrome. Two middle aged men with severe general malaise visited our clinic requesting evaluation for LOH syndrome. Previous treatments had been ineffective and based on varying incorrect diagnoses by previous doctors. The patients self referred themselves for LOH syndrome. Some of their symptoms were consistent with LOH syndrome but others were atypical, in particular, the severity of malaise and appetite loss. Hormonal assays were compatible with adrenal insufficiency secondary to ACTH deficiency. Steroid replacement dramatically improved their symptoms. The clinical course of our two patients and points of differential diagnosis between IAD and LOH syndrome are reported here.
and low serum testosterone levels [1]. However, patients with non-specific complaints such as malaise and depressive feelings based on different pathological conditions (e.g., depression) frequently visit our LOH clinic, because they misinterpreted their symptoms as LOH syndrome [2]. Among these patients, we encountered two self referred patients with isolated ACTH deficiency (IAD). Isolated ACTH deficiency is a cause of secondary adrenocortical insufficiency [3, 4]. Conspicuous symptoms of IAD are severe general malaises, appetite loss and weakness reflecting adrenal insufficiency and joint stiffness is also considered to be related to IAD [5]. These symptoms are also frequent in LOH syndrome and as non-specific complaints of elderly people, although the severities are different. Symptomatic overlap makes IAD a possible disease to be referred as LOH syndrome. The clinical courses of two cases and points of differential diagnosis between IAD and LOH syndromes are described.
Case report patient #1 Keywords Adrenal insufficiency General malaise Hypotension Isolated ACTH deficiency LOH syndrome Introduction Late-onset hypogonadism (LOH) syndrome is a clinical and biochemical condition associated with advancing age Y. Sato (&) H. Tanda H. Nakajima T. Nitta K. Akagashi T. Hanzawa M. Tobe K. Haga K. Uchida I. Honma Department of Urology, Sanjukai Hospital, Higashi Sapporo 2 Jo 3 Tyome, Shirosi-ku, Sapporo 003-0002, Japan e-mail: [email protected]
A 54-year-old male with a 2 month history of
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