Isolated adrenocorticotropin deficiency associated with polyglandular failure.

A female patient presented with isolated ACTH deficiency and diabetes mellitus. During the course of a year's replacement with hydrocortisone, goiter developed, which, on biopsy, was diagnosed as typical Hashimoto's thyroiditis. Four years later, she experienced tetany, and the diagnosis of idiopathic hypoparathyroidism was made. Immunological studies revealed the presence of antithyroid antibodies in the serum and cell-mediated immunity to the thyroid and parathyroid. These data strongly suggest that the autoimmune process is involved in the genesis of some, though not all, forms of isolated ACTH deficiency.