| Hypocortisolemia in Graves hyperthyroidism. | |
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MedLine Citation:
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PMID: 19364689 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To assess the risk of concomitant adrenal sufficiency in 2 patients with Graves thyrotoxicosis. METHODS: We present the clinical course and laboratory findings of 2 patients with hyperthyroidism associated with low basal serum cortisol and briefly review the literature with regard to possible mechanisms of hypocortisolemia in thyrotoxic states. RESULTS: Two women aged 37 and 43 years with long-standing Graves disease presented with hyperthyroidism secondary to nonadherence to prescribed antithyroid medications. Both women also had symptoms suggestive of adrenal insufficiency including nausea, vomiting, and diffuse abdominal pain in Patient 1 and fatigue and hypotension in Patient 2. In both patients, physical examination findings were consistent with hyperthyroidism. Laboratory results of Patient 1 included the following: thyrotropin, <0.002 mIU/L; free thyroxine, >6 microg/dL; and total triiodothyronine, 539 ng/dL. Laboratory results of Patient 2 included the following: thyrotropin, <0.002 mIU/L; free thyroxine, <6 microg/dL; and total triiodothyronine, 539 ng/dL. Morning basal cortisol levels were 0.9 microg/dL in Patient 1 and 0.6 microg/dL in Patient 2. Because of the low basal serum cortisol levels, the patients underwent a high-dose (250 mcg) cosyntropin-stimulation test; however, both patients had adequate cortisol response. At 60 minutes, serum cortisol concentration was 31.4 microg/dL in Patient 1 and 25.5 microg/dL in Patient 2. After adequately treating the hyperthyroidism, basal cortisol levels in both patients returned to the reference range. CONCLUSION: Symptomatic hypocortisolemia may be present in severe hyperthyroidism, and it resolves with adequate treatment of the hyperthyroidism. |
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Authors:
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Michael Karl; Barbara M Onumah; John Cole; John Golding; Kenneth D Burman; Leonard Wartofsky |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists Volume: 15 ISSN: 1934-2403 ISO Abbreviation: Endocr Pract Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-04-14 Completed Date: 2009-07-27 Revised Date: 2010-03-04 |
Medline Journal Info:
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Nlm Unique ID: 9607439 Medline TA: Endocr Pract Country: United States |
Other Details:
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Languages: eng Pagination: 220-4 Citation Subset: IM |
Affiliation:
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The Department of Medicine, Section of Endocrinology, Washington Hospital Center, Washington, DC 20010, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenal Insufficiency
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blood,
complications*,
diagnosis,
drug therapy Adult Antithyroid Agents / therapeutic use Female Graves Disease / blood, complications*, drug therapy Humans Hydrocortisone / blood* Hyperthyroidism / blood*, drug therapy, etiology Patient Compliance |
| Chemical | |
Reg. No./Substance:
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0/Antithyroid Agents; 50-23-7/Hydrocortisone |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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