Friday, February 26, 2010

Addison's disease presenting with idiopathic intracranial hypertension in a 24-year-old woman: a case report

Dushyant Sharma email, Rohini Mukherjee email, Peter Moore email and Daniel J Cuthbertson email

Journal of Medical Case Reports 2010, 4:60doi:10.1186/1752-1947-4-60

19 February 2010

Abstract (provisional)

Idiopathic intracranial hypertension can rarely be associated with an underlying endocrine disorder such as Cushing's syndrome, hyperthyroidism, or with administration of thyroxine or growth hormone. Though cases of idiopathic intracranial hypertension associated with Addison's disease in children have been reported, there is only one documented case report of this association in adults. We describe a case of an acute adrenal insufficiency precipitated by idiopathic intracranial hypertension in a Caucasian female.

Case presentation

A 24-year-old Caucasian woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure.


Addison's disease can remain unrecognised until precipitated by acute stress. This case suggests that idiopathic intracranial hypertension can rarely be associated with Addison's disease and present as an acute illness. Idiopathic intracranial hypertension is possibly related to an increase in the levels of arginine vasopressin peptide in serum and cerebrospinal fluid secondary to a glucocorticoid deficient state.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

Wednesday, February 17, 2010

Influence of hydrocortisone dosage scheme on health-related quality of life in patients with adrenal insufficiency

Authors: Bleicken, Benjamin; Hahner, Stefanie1; Loeffler, Melanie1; Ventz, Manfred2; Decker, Oliver3; Allolio, Bruno1; Quinkler, Marcus2

Source: Clinical Endocrinology, Volume 72, Number 3, March 2010 , pp. 297-304(8)

Publisher: Blackwell Publishing



Summary Context

Recent studies suggest that current glucocorticoid replacement therapies fail to completely restore well-being in patients with adrenal insufficiency (AI).



The objective of this study was to investigate health-related quality of life (QoL) in patients with AI depending on dose and frequency of daily intake of hydrocortisone (HC).


Design and patients

In a cross-sectional study, primary and secondary AI patients were contacted and asked to complete three validated self-assessment questionnaires [Short Form-36 (SF-36), Giessen Complaint List (GBB-24), Hospital Anxiety and Depression Scale (HADS)]. HC doses were corrected for body surface area. Results were compared with sex- and age-matched controls drawn from the questionnaire-specific reference cohort.



Completed questionnaire sets were available from 334 patients on HC (primary AI n = 194; secondary AI n = 140). Patients on higher doses of HC (>30 mg/day) showed significantly impaired subjective health status in two of eight SF-36 dimensions, and three of five GBB-24 scales compared with those on lower HC doses. No significant differences in QoL were found between lower HC doses (15-30 mg/day) or between primary or secondary AI. Patients on HC with thrice daily intake showed significantly impaired QoL in one of eight SF-36 dimensions (15-20 mg/day, 20-25 mg/day), in one of five GBB-24 scales (15-20 mg/day), as well as higher anxiety scores.



Health-related QoL was impaired in patients with primary and secondary AI. HC doses above 30 mg/day were associated with a worse health status. Thrice daily intake of HC was not superior to twice daily intake. Our data support the perception that current replacement strategies are still insufficient to fully restore well-being and daily performance.


Document Type: Research article

DOI: 10.1111/j.1365-2265.2009.03596.x

Affiliations: 1: Endocrinology & Diabetes Unit, Department of Medicine I, University Hospital, University of Wuerzburg, Wuerzburg, Germany 2: Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Berlin, Germany 3: Department of Psychotherapy and Psychosomatic Medicine, University Hospital Leipzig, Leipzig, Germany