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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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Bioscientifica
2024-12-01
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| Series: | Endocrinology, Diabetes & Metabolism Case Reports |
| Subjects: | |
| Online Access: | https://edm.bioscientifica.com/view/journals/edm/2024/4/EDM-24-0055.xml |
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| Summary: | 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. |
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| ISSN: | 2052-0573 |