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Pathology
ACTH deficiency as part of hypopituitarism
Aetiology
Iatrogenic – Long term steroid therapy leading to hypothalamic-pituitary-
adrenal suppression
ACTH Disorder: Any pituitary or hypothalamic disorder which causes a
reduction in ACTH
Signs
Postural hypotension, muscle wasting, vitiligo
Symptoms
Fatigue, weight loss, nausea, poor appetite, dizziness
Investigations
Bloods: Hypoglycaemia, TFTs, serum cortisol (low), serum ACTH (low), short
and long synacthen test
Treatment
Hydrocortisone 10-20mg/day in divided doses.
Prognosis
If due to steroid over replacement, then adrenal glands will recover following steroid withdrawal
Steroid over-replacement
Key Facts
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Key Images
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Key References
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