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Abstract
This 55-year-old woman presented with primary adrenal insufficiency that led to multiple
endocrine gland dysfunctions. Despite symptoms suggestive of hypothyroidism, she had
mildly elevated serum thyroid hormone levels associated with elevated thyrotropin
levels, hyperprolactinemia, and mild hypercalcemia. These abnormalities corrected
with corticosteroid replacement but could be reproduced, in part, when the corticosteroids
were temporarily withdrawn. The findings in this patient suggest that physiologic
concentrations of glucocorticoids modulate prolactin secretion and the pituitary-thyroid
axis. Adrenal insufficiency should be considered in the differential diagnosis of
hyperprolactinemia and hyperthyrotropinemia with or without associated hyperthyroxinemia.