Document Detail

Hypocortisolemia in Graves hyperthyroidism.
MedLine Citation:
PMID:  19364689     Owner:  NLM     Status:  MEDLINE    
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.
Michael Karl; Barbara M Onumah; John Cole; John Golding; Kenneth D Burman; Leonard Wartofsky
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
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:
Created Date:  2009-04-14     Completed Date:  2009-07-27     Revised Date:  2010-03-04    
Medline Journal Info:
Nlm Unique ID:  9607439     Medline TA:  Endocr Pract     Country:  United States    
Other Details:
Languages:  eng     Pagination:  220-4     Citation Subset:  IM    
The Department of Medicine, Section of Endocrinology, Washington Hospital Center, Washington, DC 20010, USA.
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MeSH Terms
Adrenal Insufficiency / blood,  complications*,  diagnosis,  drug therapy
Antithyroid Agents / therapeutic use
Graves Disease / blood,  complications*,  drug therapy
Hydrocortisone / blood*
Hyperthyroidism / blood*,  drug therapy,  etiology
Patient Compliance
Reg. No./Substance:
0/Antithyroid Agents; 50-23-7/Hydrocortisone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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