Abstract
A 79-year-old woman was admitted to our hospital for general malaise, appetite loss and fever. She was diagnosed with upper respiratory infection one month ago. After admission, high fever persisted but we couldn’t detect its cause. She started complaining of loss of consciousness, and finally drifted into shock. We suspected acute adrenal insufficiency and injected hydrocortisone after taking a blood sample for the measurement of serum cortisol and ACTH. She improved immediately upon administration of hydrocortisone. Hormonal examinations indicated that she had isolated ACTH deficiency. Patients with isolated ACTH deficiency develop signs and symptoms, which are respectively not specific, and relatively few patients complain of sustained fever. Furthermore, acute adrenal insufficiency is a life-threatening emergency. It is important to suspect adrenal insufficiency in patients with general malaise, tiredness, appetite loss, nausea, and hyponatremia, all of which occurred in our case. In conclusion, this is a rare case of isolated ACTH deficiency associated with acute adrenal insufficiency and fever.
