Clinical and Experimental Nephrology

, Volume 14, Issue 2, pp 168–172 | Cite as

Focal segmental glomerulosclerosis in a patient with isolated ACTH deficiency and reversible hypothyroidism

  • Shunsuke Yamada
  • Sachiko Bandai
  • Kohsuke Masutani
  • Akihiro Tsuchimoto
  • Hideko Noguchi
  • Mikio Munakata
  • Kazuhiko Tsuruya
  • Mitsuo Iida
Case Report
First Online:
Received:
Accepted:

Abstract

A 23-year-old man was admitted to our hospital for fatigue, anorexia, proteinuria, and peripheral edema. Proteinuria was first pointed out at the age of 15, but no further studies were performed. Six years prior to admission, the patient noted becoming easily fatigued. Laboratory tests on admission showed marked peripheral eosinophilia (29.2%, count: 1,071/μL) and proteinuria. Endocrinological studies revealed isolated adrenocorticotropic hormone deficiency with primary hypothyroidism, but a lack of autoimmune thyroiditis. Renal biopsy showed focal segmental glomerulosclerosis. Hydrocortisone therapy (30 mg/day) for isolated adrenocorticotropic hormone deficiency resulted in marked improvement of adrenal and thyroid functions, and amelioration of proteinuria (from 2.8 to 1.0 g/day) over a two-month period. Renal function remains normal at five years after the start of hydrocortisone treatment. The findings suggest that both hydrocortisone therapy and normalized thyroid hormone status played a pivotal role in the improvement of proteinuria associated with focal segmental glomerulosclerosis.

Keywords

Adrenal insufficiency Focal segmental glomerulosclerosis Isolated adrenocorticotropic hormone deficiency Reversible hypothyroidism 
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Notes

Acknowledgment

We thank Dr. F.G. Issa (http://www.word-medex.com.au) for carefully reading and editing this manuscript.

Conflict of interest statement

No conflicts of interest disclosed.

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Copyright information

© Japanese Society of Nephrology 2009

Authors and Affiliations

  • Shunsuke Yamada
    • 1
  • Sachiko Bandai
    • 1
  • Kohsuke Masutani
    • 1
  • Akihiro Tsuchimoto
    • 1
  • Hideko Noguchi
    • 1
  • Mikio Munakata
    • 2
  • Kazuhiko Tsuruya
    • 1
    • 3
  • Mitsuo Iida
    • 1
  1. 1.Department of Medicine and Clinical Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  2. 2.Department of PathologyFukuoka Red Cross HospitalFukuokaJapan
  3. 3.Department of Integrated Therapy for Chronic Kidney DiseaseGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan

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