CASE REPORT: AN INTERESTING CASE OF A MIDDLE-AGED WOMAN DIAGNOSED WITH ISOLATED ACTH DEFICIENCY CO-EXISTING WITH NON-FUNCTIONING ADRENAL INCIDENTALOMA IN A DISTRICT GENERAL HOSPITAL IN THE UK

We describe here a a woman who presented to the Endocrine Clinic in 2015 at the age of 50 years in a wheelchair with extreme lethargy, chronic pain and low morning Serum Cortisol. The patient had a Glucagon Stimulation Test. The results hinted towards Cortisol and Partial GH (Growth Hormone) deficiency. This was followed by an IGF-1 (Insulin like Growth Factor-1) estimation which was low and also had a SST (Short Synacthen Test) with base line ACTH (Adrenocorticotrophic Hormone) with the results showing a normal Plasma ACTH level and low morning Cortisol with inadequate response to Synacthen. The IGF-1 result later normalised. Two years later, the patient had a CT abdomen followed by CT adrenals with contrast done which showed a left adrenal adenoma which biochemically proved to be non-secretory. Thus, this middle-aged woman had Partial Isolated ACTH deficiency and left sided non- functional (non-secretory). adrenal incidentaloma. This case report of the combination of the two entities is unique as this is unlike the recent report of Isolated ACTH deficiency co-existing with mild autonomous Cortisol secreting Adrenal Incidentaloma (MACS).