Binyrebarkfunksjonen kan bli nedsatt hos pasienter med primær hypotyreose.

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"Adrenal function might be impaired in patients with primary hypothyroidism."

Int J Endocrinol. 2014; 2014: 313519.
Published online 2014 Aug 7. doi: 10.1155/2014/313519
PMCID: PMC4142294

Glucocorticoid Functional Reserve in Full-Spectrum Intensity of Primary Hypothyroidism
René Rodríguez-Gutiérrez, Camilo González-Velázquez, Gerardo González-Saldívar, Jesús Zacarías Villarreal-Pérez and José Gerardo González-González.

Abstract

Adrenal function might be impaired in patients with primary hypothyroidism. The objective was to evaluate adrenocortical function using the low-dose cosyntropin test in patients with primary hypothyroidism. Consequently a prospective, longitudinal, controlled study of sixty adult patients with primary hypothyroidism was carried out. Patients naïve to L-T4 treatment were compared with control participants. A low-dose cosyntropin test was done before and after L-T4 therapy. Thirty and sixty minutes after the low-dose cosyntropin, the mean cortisol values were lower in the cases group (612.6 ± 133.1 and 603.4 ± 153.7 nmol/L) when compared to the control group (677.0 ± 82.4 and 669.9 ± 83.7 nmol/L) (P = 0.001 and 0.003), respectively. After L-T4 therapy, this difference was lost. Four out of 60 cases (6.7%) taking a cortisol cutoff value of 500 mmol/L and 11 out of 60 (18.3%) having 550 mmol/L as the cutoff had adrenal insufficiency before L-T4 therapy. After L-T4 therapy, 50% and 81% of the cases had normal cortisol response. In conclusion, patients with different degrees of intensity of primary hypothyroidism had improved cortisol response after reaching euthyroidism. The incidence of adrenal insufficiency was 6.7–18.3% and more than 50% of the cases had a normal cortisol response after L-T4 therapy. (...)

In conclusion, this prospective study of patients with different severities of primary hypothyroidism showed, using the low-dose cosyntropin test, an improved cortisol response after normalization of thyroid hormone levels. The mechanism of impaired cortisol secretion in cases with hypothyroidism still has to be elucidated but our data support an adrenal rather than a pituitary affection. The incidence of adrenal insufficiency was 6.7–18.3% and more than 50% of the cases had a normal cortisol response after L-T4 therapy. Remarkably, 25–50% of the cases were in the subclinical/mild/moderate hypothyroidism groups. This finding could have important clinical implications especially in the setting of acute stress situations occurring during the period while a euthyroid state is still not achieved.

Source / Read more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4142294/