Four weeks later, free T4 and adrenal androgens normalized. Maintenance hydrocortisone dose was 25 mg/m 2/day and was not changed. Adrenal androgens were markedly elevated. Labs showed suppressed TSH, elevated free T4 and total T3, and elevated thyroid stimulating immunoglobulin (TSI) consistent with Graves’ disease. In the previous 9 months, she unintentionally lost 2.6 kg. A 12-year-old girl with SW-CAH reported 3 recent episodes of vomiting without diarrhea, and accompanying tachycardia, responsive to stress dose steroids. In patients with salt-wasting congenital adrenal hyperplasia (SW-CAH), hyperandrogenemia is a measurable reflection of relative glucocorticoid insufficiency. In a thyrotoxic state, individuals with adrenal insufficiency are unable to increase endogenous cortisol production to compensate for increased turnover, placing them at risk for symptoms of glucocorticoid deficiency and adrenal crisis.
Thyroid hormone is known to accelerate glucocorticoid turnover.
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