Adrenal Insufficiency Secondary to Hypothalamic Corticotropin Releasing Factor (CRF) Insufficiency with Hyperpigmentation: A Case Report

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Abstract
Partial adrenocortical insufficiency as a result of an insufficiency of the hypothalamic corticotropin releasing factor (CRF) was demonstrated in a 53-year-old female patient. Somatotropic, gonadotropic and thyrotropic functions of the pituitary gland were shown to be normal by a simultaneous pituitary stimulation test. This held true especially for the adrenocorticotrophic function: administration of lysinevasopressin induced a normal rise in immunoreactive plasma- ACTH. Thus, a pituitary defect as primary cause of the disease could be excluded and evidence was provided that there was a lack in hypothalamic stimulation of ACTH-secretion. An enigmatic feature in this patient was that in the absence of elevated ACTH levels hyperpigmentation of the skin existed. Possible explanations are discussed. 1 Supported by the Deutsche Forschungsgemeinschaft, Project B2 (SFB 87)