Six patients with panhypopituitarism and adrenocortical hormone unresponsiveness to intravenously administered ACTH are presented. In comparison to 14 patients whose urine 17-ketogenic steroid excretion followed a well-described stepwise increase with daily intravenous ACTH infusions, these patients showed no significant change for as long as 5 days. The clinical history and an adequate aldosterone and sodium response to a low sodium diet were evidence against associated primary adrenal insufficiency. The urinary steroid excretion response to infused ACTH may fail to distinguish primary from secondary adrenocortical failure.
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Chakmakjian et al. (1968) studied this question.