Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol
An oral contraceptive pill (OCP)-induced increase in total cortisol lead to reversible suppression of the hypothalamic–pituitary–adrenal (HPA) axis and insulin resistance (IR) in a patient with Addison’s disease. We suggest that this might influence the choice of an OCP in such patients. A 20-year-o...
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Bioscientifica
2024-12-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
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| author | Krzysztof C Lewandowski Monika Głuchowska Małgorzata Karbownik-Lewińska Andrzej Lewiński |
| author_facet | Krzysztof C Lewandowski Monika Głuchowska Małgorzata Karbownik-Lewińska Andrzej Lewiński |
| author_sort | Krzysztof C Lewandowski |
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| description | An oral contraceptive pill (OCP)-induced increase in total cortisol lead to reversible suppression of the hypothalamic–pituitary–adrenal (HPA) axis and insulin resistance (IR) in a patient with Addison’s disease. We suggest that this might influence the choice of an OCP in such patients. A 20-year-old female was diagnosed with Addison’s disease (cortisol: 44 nmol/L, adrenocorticotropic hormone (ACTH): >500 pg/mL) and started on hydrocortisone (HC). Few months later, an OCP (30 μg ethinyl oestradiol (EE) and 3 mg drospirenone) was added. Total cortisol was above the upper assay detection limit (UADL), while ACTH was inappropriately ‘normal’: cortisol 8:00 (pre-dose) 83 nmol/L, post-dose 10:00 >1757 nmol/L, ACTH 8:00 (pre-dose) 24.1 pg/mL and post-dose 10:00 3.8 pg/mL. Even 5 mg of oral HC induced an increase in cortisol above UADL. The glucagon stimulation test (GST) showed brisk growth hormone secretion. The corticotropin-releasing hormone (CRH) test showed partial hypothalamic suppression of CRH release: minimal ACTH 42.4 pg/mL and maximal ACTH 87.3 pg/mL, i.e. relatively low levels for all cortisol concentrations <69 nmol/L. Withdrawal of the OCP resulted in the return of high ACTH concentrations typical for patients with Addison’s disease on HC replacement. There was also a marked improvement in insulin resistance (a fall in homeostasis model assessment - insulin resistance (HOMA-IR) from 3.64 to 1.69 and a marked decline in mean insulin concentrations during GST). EE administration resulted in a massive increase in total cortisol with suppression of the HPA axis and IR suggestive of relative hypercortisolaemia. This raises the question of whether EE should be avoided as a contraceptive agent in women with adrenal failure. |
| format | Article |
| id | doaj-art-65bb47cd2afa4d3e87589980d1578a12 |
| institution | OA Journals |
| issn | 2052-0573 |
| language | English |
| publishDate | 2024-12-01 |
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| series | Endocrinology, Diabetes & Metabolism Case Reports |
| spelling | doaj-art-65bb47cd2afa4d3e87589980d1578a122025-08-20T01:57:20ZengBioscientificaEndocrinology, Diabetes & Metabolism Case Reports2052-05732024-12-012024410.1530/EDM-24-00551Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisolKrzysztof C Lewandowski0Monika Głuchowska1Małgorzata Karbownik-Lewińska2Andrzej Lewiński3Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, PolandDepartment of Pathology of Pregnancy, 1st Chair of Gynaecology and Obstetrics, Medical University of Lodz, Lodz, PolandDepartment of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, PolandDepartment of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital – Research Institute, Lodz, PolandAn oral contraceptive pill (OCP)-induced increase in total cortisol lead to reversible suppression of the hypothalamic–pituitary–adrenal (HPA) axis and insulin resistance (IR) in a patient with Addison’s disease. We suggest that this might influence the choice of an OCP in such patients. A 20-year-old female was diagnosed with Addison’s disease (cortisol: 44 nmol/L, adrenocorticotropic hormone (ACTH): >500 pg/mL) and started on hydrocortisone (HC). Few months later, an OCP (30 μg ethinyl oestradiol (EE) and 3 mg drospirenone) was added. Total cortisol was above the upper assay detection limit (UADL), while ACTH was inappropriately ‘normal’: cortisol 8:00 (pre-dose) 83 nmol/L, post-dose 10:00 >1757 nmol/L, ACTH 8:00 (pre-dose) 24.1 pg/mL and post-dose 10:00 3.8 pg/mL. Even 5 mg of oral HC induced an increase in cortisol above UADL. The glucagon stimulation test (GST) showed brisk growth hormone secretion. The corticotropin-releasing hormone (CRH) test showed partial hypothalamic suppression of CRH release: minimal ACTH 42.4 pg/mL and maximal ACTH 87.3 pg/mL, i.e. relatively low levels for all cortisol concentrations <69 nmol/L. Withdrawal of the OCP resulted in the return of high ACTH concentrations typical for patients with Addison’s disease on HC replacement. There was also a marked improvement in insulin resistance (a fall in homeostasis model assessment - insulin resistance (HOMA-IR) from 3.64 to 1.69 and a marked decline in mean insulin concentrations during GST). EE administration resulted in a massive increase in total cortisol with suppression of the HPA axis and IR suggestive of relative hypercortisolaemia. This raises the question of whether EE should be avoided as a contraceptive agent in women with adrenal failure.https://edm.bioscientifica.com/view/journals/edm/2024/4/EDM-24-0055.xmladdison’s diseasehypothalamic–pituitary–adrenal axisethinyl oestradiolcortisol |
| spellingShingle | Krzysztof C Lewandowski Monika Głuchowska Małgorzata Karbownik-Lewińska Andrzej Lewiński Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol Endocrinology, Diabetes & Metabolism Case Reports addison’s disease hypothalamic–pituitary–adrenal axis ethinyl oestradiol cortisol |
| title | Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol |
| title_full | Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol |
| title_fullStr | Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol |
| title_full_unstemmed | Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol |
| title_short | Reversible suppression of hypothalamo–pituitary–adrenal axis in Addison’s disease due to ethinyl oestradiol-induced increase in total cortisol |
| title_sort | reversible suppression of hypothalamo pituitary adrenal axis in addison s disease due to ethinyl oestradiol induced increase in total cortisol |
| topic | addison’s disease hypothalamic–pituitary–adrenal axis ethinyl oestradiol cortisol |
| url | https://edm.bioscientifica.com/view/journals/edm/2024/4/EDM-24-0055.xml |
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