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Isolated ACTH deficiency presenting with bilateral frozen shoulder.
E H Choy1, M M Corkill, T Gibson
1Rheumatology Unit, Guy's Hospital, London.
British Journal of Rheumatology
|June 1, 1991
Summary
Isolated ACTH deficiency can cause fatigue, depression, and frozen shoulders in adults. Prompt steroid replacement therapy effectively resolves these symptoms, highlighting the importance of diagnosing adrenal insufficiency.
Area of Science:
- Endocrinology
- Internal Medicine
- Rheumatology
Background:
- Adrenal insufficiency is a rare endocrine disorder characterized by inadequate production of adrenal hormones.
- Symptoms can be nonspecific, including fatigue, depression, and musculoskeletal complaints, potentially delaying diagnosis.
Observation:
- A 55-year-old female presented with a year of lethargy, depression, and painful, stiff joints.
- Bilateral frozen shoulders were the most prominent clinical finding, with initial treatment providing a diagnostic clue.
- Investigations revealed profound hypocortisolism due to isolated adrenocorticotropic hormone (ACTH) deficiency.
Findings:
- Isolated ACTH deficiency was diagnosed in the absence of an identifiable cause.
- Corticosteroid replacement therapy led to complete resolution of fatigue within 3 months.
- The symptoms of frozen shoulders resolved entirely following steroid replacement.
Implications:
- This case underscores the potential for isolated ACTH deficiency to manifest with rheumatological symptoms like frozen shoulders.
- Early diagnosis and treatment of adrenal insufficiency are crucial for managing debilitating symptoms and preventing complications.
- Highlighting the link between endocrine disorders and musculoskeletal manifestations is important for comprehensive patient care.