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Isolated ACTH deficiency presenting with a glucocorticoid-responsive triphasic wave coma.
Toshihisa Sugita1, Masashi Nakajima, Daisuke Arai
1Department of Neurology, Tokyo Rosai Occupational Diseases and Injuries Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|July 24, 2012
Summary
A rare cause of acute coma, isolated ACTH deficiency, can present with electroencephalographic triphasic waves and resolve with glucocorticoids. This diagnosis should be considered in unexplained encephalopathy.
Area of Science:
- Neurology
- Endocrinology
Background:
- Acute encephalopathy and coma of unknown origin present a diagnostic challenge.
- Electroencephalographic abnormalities, such as triphasic waves (TWs), can indicate underlying neurological dysfunction.
Observation:
- A 58-year-old woman presented with sudden onset coma and electroencephalographic triphasic waves without metabolic disturbances.
- Her symptoms resolved rapidly following glucocorticoid administration.
Findings:
- The patient was diagnosed with isolated ACTH deficiency.
- This condition can manifest as acute, glucocorticoid-responsive encephalopathy without typical metabolic derangements like hypoglycemia or hyponatremia.
Implications:
- Isolated ACTH deficiency is a rare but treatable cause of acute encephalopathy and coma.
- Electroencephalographic triphasic waves may serve as a diagnostic clue for this condition in patients with unexplained coma.
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