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Acute adrenal crisis precipitated by thyroxine.
Open accessAbstract
It is well recognised that in patients with pituitary insufficiency thyroid hormone replacement without concomitant adrenal steroid replacement may precipitate an acute adrenal crisis.'It is less widely appreciated that similar problems may arise during treatment of primary myxoedema if the patient also has unrecognised or subclinical adrenocortical disease.We report on two patients with primary hypothyroidism in whom thyroxine replacement precipitated an acute addisonian crisis.Case reports CASE 1A 47 year old woman had presented elsewhere three years previously with a history of lethargy.No clinical or biochemical abnormality had been detected.Her symptoms persisted, and two years later a low serum thyroxine concentration and a-raised serum thyroid stimulating hormone concentration were recorded.Plasma urea and electrolyte concentrations were normal.She was prescribed thyroxine 50 tg daily, increasing to 100 tg after two weeks, but felt ill and dizzy, lost weight, and stopped taking the Royal Free Hospital School ofMedicine, London NW3 2QG
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Initiation of T4 replacement may induce adrenal crisis due to increased cortisol metabolism.
“Initiation of T 4 replacement may induce adrenal crisis due to increased cortisol metabolism (130).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [130]
The paper reports two adrenal crises precipitated by thyroxine replacement in patients with underlying adrenal insufficiency. Its Discussion proposes that thyroxine raises the body's metabolic rate and thereby increases the need for adrenal steroid secretion; it does not specifically attribute the crises to increased cortisol metabolism. (LLM, conf=0.85)
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References 4 · Cited by 44
Research works printed but not linked: 5
- I Veldhuis JD. Hypopituiuism. In: Krieger DT, Bardin CW, eds. Cwren dhrapy sn eudcr6noogy asd seahbolism. Burlington, Ontario: B C DeCer Inc, 1985:16-20.
- Appel GB, Holub DA. The syndrome of multiple endocrine gland insufficiency. Am J Med 1976;61:129-32. · DOI
- Doniach D, Bottazzo GF, Russell RCG. Goitrous autoimmune thyroiditis (Hashimoto's disease). ClinEdocriuolMetab 1979;8:63-80.
- Havard CWH, Saldanha VF, Bird R, Garner R. Adrenal function in hypothyroidism. Br Med 1970;i:337-9.
- Levin ME, Daughaday WH. The influence of the thyroid on adrenocortical function. J Cl EndocriolMe,ab 1955;15:1499-5 1. · DOI
Metadata
- Authors
- Fonseca, V, Brown, R., Hochhauser, D., Ginsburg, J., & Havard, C. W.
- Affiliations
- The Royal Free Hospital (GB)
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 1986-05-03
- Volume
- 292
- Issue
- 6529
- Pages
- 1185-1186
- ISSN
- 0007-1447 (ISSN-L)
- 0267-0623
- 1468-5833
- OpenAlex
- W1975759253
- Cited by
- 44
- References
- 4
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 3 · 2023: 4 · 2022: 1 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 4 · 2017: 3 · 2016: 1 · 2014: 1 · 2013: 1
- FWCI
- 0.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.bmj.com/company/legal-information/terms-conditions/legal-information/tdm-licencepolicy (tdm)
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
- Keywords
- adrenal crisis, thyroxine, primary hypothyroidism, hypopituitarism, thyroid hormone replacement, hyperthyroidism
- MeSH terms
- Acute Disease, Adrenal Gland Diseases, Adult, Female, Humans, Male, Middle Aged, Thyroxine
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