Adrenocorticotropic hormone deficiency [Neurosurgery Wiki]

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====== Adrenocorticotropic hormone deficiency ======

[[Adrenocorticotropic hormone]] deficiency is a result of a decreased or absent production of [[adrenocorticotropic hormone]] (ACTH) by the [[pituitary gland]].

It can be associated with [[TBX19]].
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Secondary [[adrenal insufficiency]] (AI), including isolated [[adrenocorticotropic hormone]] (ACTH) deficiency (IAD), is often associated with [[hyponatremia]]. 

Hinata et al. reported an unusual case of [[Immune checkpoint inhibitor]] (ICI)-related IAD associated with severe [[hyperkalemia]]. 

A 78-year-old woman who had an ileal conduit, chronic kidney disease, type 2 diabetes mellitus, and hypertension and was taking an angiotensin II receptor blocker began treatment for advanced ureteral cancer with the anti-programmed cell death protein 1 inhibitor [[pembrolizumab]]. The therapy effectively controlled [[cancer]], but 4 1/2 months after starting it, the patient developed [[anorexia]], general [[weakness]], and muscle pain and was diagnosed with IAD associated with severe [[hyperkalemia]] and hyperchloremic metabolic acidosis. She recovered after prompt administration of [[corticosteroid]]s and treatment with [[sodium bicarbonate]], [[glucose]]/[[insulin]], and cation exchange resins. 

[[Hyperkalemia]] is a common symptom of primary [[adrenal insufficiency]] (AI) but is less common in patients with central AI because a lack of [[ACTH]] does not cause [[aldosterone]] deficiency and [[mineralocorticoid]] action is preserved. A case demonstrates the need for physicians to be aware of severe hyperkalemia as a life-threatening complication of secondary AI induced by ICIs, particularly in patients with predisposing factors, such as kidney dysfunction, diabetes mellitus, an ileal conduit, and renin-angiotensin-aldosterone system inhibitor use
((Hinata Y, Ohara N, Sakurai Y, Koda R, Yoneoka Y, Takada T, Hara N, Nishiyama T. Isolated Adrenocorticotropic Hormone Deficiency Associated with Severe Hyperkalemia During Pembrolizumab Therapy in a Patient with Ureteral Cancer and an Ileal Conduit: A Case Report and Literature Review. Am J Case Rep. 2021 Jul 15;22:e931639. doi: 10.12659/AJCR.931639. PMID: 34262010.)).

===== Posttraumatic hypopituitarism =====

see [[Posttraumatic hypopituitarism]]