Chronic Haemolytic Anemia and Splenomegaly in a Patient with an Isolated Adrenocorticotropin Deficiency

Rania Abdel-Muneem Ahmed, Koji Murao, Hitomi Imachi, Noriko Kitanaka, Tomie Muraoka, Kensuke Matsumoto, Takamasa Nishiuchi, Yukiko Nishiuchi and Toshihiko Ishida Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe Miki-CHO, Kita-gun, Kagawa, Japan. Abstract Herein we describe a case of a 56-years old patient presented with general malaise, anorexia and progressive weight loss for about 5years associated recently with diarrhoea and repeated syncopal attacks for 1month. On admission, he had splenomegaly and his laboratory studies showed macrocytic hyperchromic haemolytic anemia [Hb = 9.4g/dl] and a significant hyponatremia [Na+ = 111mmol/l]. Endocrinological evaluation revealed an isolated adrenocorticotropin deficiency (IAD) with a manifest hypoaldosteronism. On treatment with cortisone, both anemia and hyponatremia (but not splenomegaly) were markedly improved. Our case may represent an evidence for the pathogenesis of erythropoietic dysfunction in patients of adrenocortical insufficiency.