Variant Angina in Isolated Adrenocorticotropin Deficiency, Inappropriate Vasopressin Secretion and Hashimoto's Thyroiditis

We report a 62-year-old male patient who had variant angina and isolated adrenocorticotropic hormone(ACTH) deficiency. His serum sodium concentration was low and vasopressin was inappropriately high for the low plasma osmolality. Serum free thyroxine (FT4) was low and thyroid stimulating hormone (TSH) was high with positive anti-thyroperoxidase antibodies, compatible with Hashimoto's thyroiditis. Treatment with Amrodipine and hydrocortisone relieved chest symptoms and hyponatremia, and hypothyroidism was also normalized. It is suggested that coronary artery spasm may be related to cortisol deficiency and/or inappropriately high vasopressin secretion and that hypothyroidism was ameliorated because the reduced responsiveness to TSH returned to normal due to hydrocortisone supplement. (Internal Medicine 37: 398-402, 1998)