case_images: PMC8995658_01
case_images: Results of CRH loading test in May 2019. Six days after hospital admission, we performed CRH loading test. Cortisol levels before loading test were below the normal range (1.26 mug/dL) and loading response was impaired. Though ACTH responded, both ACTH levels before loading test and peak levels of ACTH were low. Therefore, the pituitary gland might have been impaired partially. Normal range of cortisol: 6.24-18 mug/dL. Normal range of ACTH: 7.2-63.3 pg/mL. Solid line: cortisol. Dotted line: ACTH. CRH, corticotropin-releasing hormone.
case_images: cde-0014-0055-g01.jpg
case_images: PMC8995658_01_cde-0014-0055-g01.jpg
case_images: F1
case_images: As we did not get a definitive diagnosis, corticotrophin-releasing hormone loading test was performed (day X+6) (Fig. 1). Cortisol levels before loading test were below the normal range and loading response was impaired (Fig. 1). Though ACTH responded, both ACTH levels before loading test and peak levels of ACTH were low (Fig. 1).
case_images: Sagittal and coronal sections of T1-weighted MRI taken 8 days after hospital admission. The pituitary gland was not enlarged (height, 5.8 mm; length, 9.7 mm; width, 9.3 mm).
case_images: cde-0014-0055-g02.jpg
case_images: PMC8995658_01_cde-0014-0055-g02.jpg
case_images: F2
case_images: We took a brain MRI, and no enlargement of the pituitary gland was noted (day X+8) (Fig. 2).