Chiari–Frommel Syndrome in a Patient with Primary Adrenocortical Insufficiency

For fourteen months post partum a 31-yearold woman had amenorrhea, galactorrhea, hyperpigmentation, and loss of sexual hair. A diagnosis of primary adrenocortical insufficiency was supported by low serum and urinary cortisol, high serum ACTH, circulating adrenal antibodies, aldosterone deficiency, failure to respond to exogenous ACTH, and a normal sella turcica, growth hormone, thyrotropin, and luteinizing and follicle-stimulating hormones. Base-line human prolactin levels were slightly but consistently elevated to 26 to 29 ng per milliliter. Replacement with 37.5 mg of cortisone acetate per day resulted within three weeks in spontaneous resumption of regular menstrual cycles, disappearance of galactorrhea, weight gain and regression of pigmentary changes. Serum ACTH returned to normal, and prolactin levels decreased to 10 to 11 ng per milliliter. Thus, glucocorticoid deficiency due to primary adrenocortical insufficiency can produce persistent prolactin elevation with galactorrhea in the hormona...