Is it possible to have undetectable cortisol levels in secondary adrenal insufficiency?

Topics: Endocrinology • Adrenal Disorders

Young, previously healthy male with normal growth presenting with two syncopal episodes. Currently, only symptom is mild fatigue. Labs showed: Cortisol undetectable with ACTH 6-8, cortisol levels did not rise with cosyntropin but aldosterone stimulated normally, low IGF1, mildly elevated prolactin, elevated TSH and low free T4 (normalized later). CBG wnl and opiate/steroid assay were negative. MRI with small pituitary. Some of my colleagues think it is interference or assay issue, others think this is true central AI.

Answer from: at Community Practice

Yes, you can certainly have undetectable cortisol in central AI. Low IGF-1 and low-normal FT4 would suggest hypopituitarism. Do you have a testosterone level? I would perform a GH stimulation test. An abnormal test would confirm pituitary pathology. Before this, however, I would carefully investigat...

Comments

at Endocrine Associates Of Connecticut
Thank you so much. No exogenous steroid use and le...

at Johns Hopkins Endocrinology and Pituitary Center
Very strange to see such a high T level. I wonder ...

at Endocrine Associates Of Connecticut
Hi, thanks for the info. I was not aware that macr...

Answer from: at Academic Institution

I agree with Dr. @Salvatori, it is very strange to see these elevated testosterone levels. And also to start thyroid replacement while trying to work through this. I have a few clarifying questions. What work does he do? What are his hobbies/athletic interests? Do you have a testicular exam o...

Comments

at Endocrine Associates Of Connecticut
Hi Dr. @Khan thank you so much. He is now 20+, wor...

at University of Missouri School of Medicine
A germ cell tumor can cause pituitary dysfunction ...

at Endocrine Associates Of Connecticut
Thank you and will write back with update.

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