Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency
Context. Transient secondary adrenal insufficiency (SAI) is an expected complication following successful adenomectomy of ACTH-secreting pituitary adenomas or unilateral adrenalectomy for cortisol-secreting adrenal adenomas. To date, no pharmacological therapy has been shown to hasten recovery of th...
Saved in:
| Main Author: | |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | Case Reports in Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2016/4709597 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832556721048911872 |
|---|---|
| author | Pejman Cohan |
| author_facet | Pejman Cohan |
| author_sort | Pejman Cohan |
| collection | DOAJ |
| description | Context. Transient secondary adrenal insufficiency (SAI) is an expected complication following successful adenomectomy of ACTH-secreting pituitary adenomas or unilateral adrenalectomy for cortisol-secreting adrenal adenomas. To date, no pharmacological therapy has been shown to hasten recovery of the hypothalamic-pituitary-adrenal (HPA) axis in this clinical scenario. Case Description. A 33-year-old woman underwent uncomplicated unilateral adrenalectomy for a 3.7 cm cortisol-secreting adrenal adenoma. Postoperatively, she developed SAI and was placed on hydrocortisone 15 mg/day, given in divided doses. In the ensuing six years, the patient’s HPA axis failed to recover and she remained corticosteroid-dependent. Quarterly biochemical testing (after withholding hydrocortisone for 18 hours) consistently yielded undetectable serum cortisol and subnormal plasma ACTH levels. While she was on hydrocortisone 15 mg/day, mifepristone was initiated and gradually titrated to a maintenance dose of 600 mg/day after 5 months. Rapid recovery of the HPA axis was subsequently noted with ACTH rising into the supranormal range at 4 months followed by a subsequent rise in cortisol levels into the normal range. After 6 months, the dose of hydrocortisone and mifepristone was lowered and both were ultimately stopped after 8 months. The HPA axis remains normal after an additional 16 months of follow-up. Conclusion. Mifepristone successfully restored the HPA axis in a woman with prolonged secondary adrenal insufficiency (SAI) after adrenalectomy for Cushing’s syndrome (CS). |
| format | Article |
| id | doaj-art-fb14c97652d5428c88844d9d208cbc1a |
| institution | Kabale University |
| issn | 2090-6501 2090-651X |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Endocrinology |
| spelling | doaj-art-fb14c97652d5428c88844d9d208cbc1a2025-02-03T05:44:40ZengWileyCase Reports in Endocrinology2090-65012090-651X2016-01-01201610.1155/2016/47095974709597Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal InsufficiencyPejman Cohan0Specialized Endocrine Care Center, 150 North Robertson Boulevard, Suite 210, Beverly Hills, CA 90211, USAContext. Transient secondary adrenal insufficiency (SAI) is an expected complication following successful adenomectomy of ACTH-secreting pituitary adenomas or unilateral adrenalectomy for cortisol-secreting adrenal adenomas. To date, no pharmacological therapy has been shown to hasten recovery of the hypothalamic-pituitary-adrenal (HPA) axis in this clinical scenario. Case Description. A 33-year-old woman underwent uncomplicated unilateral adrenalectomy for a 3.7 cm cortisol-secreting adrenal adenoma. Postoperatively, she developed SAI and was placed on hydrocortisone 15 mg/day, given in divided doses. In the ensuing six years, the patient’s HPA axis failed to recover and she remained corticosteroid-dependent. Quarterly biochemical testing (after withholding hydrocortisone for 18 hours) consistently yielded undetectable serum cortisol and subnormal plasma ACTH levels. While she was on hydrocortisone 15 mg/day, mifepristone was initiated and gradually titrated to a maintenance dose of 600 mg/day after 5 months. Rapid recovery of the HPA axis was subsequently noted with ACTH rising into the supranormal range at 4 months followed by a subsequent rise in cortisol levels into the normal range. After 6 months, the dose of hydrocortisone and mifepristone was lowered and both were ultimately stopped after 8 months. The HPA axis remains normal after an additional 16 months of follow-up. Conclusion. Mifepristone successfully restored the HPA axis in a woman with prolonged secondary adrenal insufficiency (SAI) after adrenalectomy for Cushing’s syndrome (CS).http://dx.doi.org/10.1155/2016/4709597 |
| spellingShingle | Pejman Cohan Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency Case Reports in Endocrinology |
| title | Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency |
| title_full | Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency |
| title_fullStr | Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency |
| title_full_unstemmed | Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency |
| title_short | Mifepristone Accelerates HPA Axis Recovery in Secondary Adrenal Insufficiency |
| title_sort | mifepristone accelerates hpa axis recovery in secondary adrenal insufficiency |
| url | http://dx.doi.org/10.1155/2016/4709597 |
| work_keys_str_mv | AT pejmancohan mifepristoneaccelerateshpaaxisrecoveryinsecondaryadrenalinsufficiency |