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류형선(Hyung Sun Ryeu),심승식(Seung Sig Sim),정만(Mann Jung),박창현(Chang Hyun Park),박찬웅(Chan Woong Park),이영미(Young Mi Lee),천석배(Seok Bae Cheon),강상구(Sang Ku Kang),문용(Yong Moon),김지운(Ji Woon Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.4
Background: Combined ATCH and GH deficiency is a rare disease, Clinical and laboratory features are variable, non-specific and similar to those seen in adrenocortical insufficiency of any cause. Methods: We have exprienced a case of combined ACTH and GH deficiency without combined disease. The patient, 55 years old female, was admitted because of fatigue, nausea and vomiting on admission. Results: Serum sodium was 112 mmol/L, potassium 3. Hmmol/L, serum osmolarity 237m0sm,Kg and urine osmolarity 531 m0sm/Kg. Basal serum cortisol was 0.68 μg/ml, ACTH 12,7pgjml, GH below 0.1 ng/ml, basal urinary 17-hydroxycorticosteroid(17-OHCS) 0.5 μg/dl and blood glucose was 86 mg/dl. Although cortisol did not respond to rapid ACTH stimulation test, it responded to standard ACTH stimulation test. On combinded stimulation test, the cortis1 did not respond and all anterior pituitary hormone showed normal responses except ACTH and GH. In addition, plasma cortisol and ACTH repond to vasopressin test. There was no abnormalities in sellar CT, and hyponatremia was corrected dramatically with prednisolone replacement. Conclusion: Combined ACTII and GI-I deficiency is rare cause of secondary adrenocortical insufficiency, Its clinical manifestation similar to isolated ACTH deficiency in adult. Patients with isolated ACTFI deficiency due to suprapituitary dysfunction may be distinguished from those with intrinsic pituitary disease by stimulation of cortisol and ACTI-I secretion following vasopressin administration. More study needed to identify the definitive cause and hypothalamic-pituitary system.