A Case of Isolated ACTH Deficiency with Suspected Origin from Cervical Spondylotic Myelopathy

The patient was a 46-year-old man who presented with fatigue for 6 months. His activities of daily living (ADL) gradually worsened and he transported to our hospital’s emergency room because difficulty in walking due muscle weakness the extremities. weight had decreased by 20 kg months, almost bedridden. Upon arrival, emaciation, hypotension, predominantly proximal portions. However, showed no clumsiness hands, pain, sensory disorders, or bladder-rectal disturbances. Only Hoffman’s reflex positive. Deep tendon reflexes were normal his upper limbs but flaccid lower limbs. Japan Orthopaedic Association (JOA) score 14/17. Images cervical spine developmental narrow canal, spondylotic changes at C4-7 levels, spinal cord compression myelomalacia C4-6 levels. These findings suggested myelopathy (CSM). laboratory data mild hyponatremia (sodium 135 mmol/L) hypothyroidism (free thyroxine [T4] 1.00 ng/ml, thyroid-stimulating hormone [TSH] 6.62 µIU/ml). Based on radiology, endocrinology, neurology consultations, diagnosed an isolated adrenocorticotropic (ACTH) deficiency. Hydrocortisone (20 mg/day) administration dramatically improved symptoms ADL. JOA 17/17 over few returned life. He has been followed-up without surgery until now.