{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:02:51Z","timestamp":1756425771765,"version":"3.44.0"},"reference-count":21,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,9,22]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>Isolated adrenocorticotropic hormone deficiency (IAD) is a rare disorder but not a known cause of hyperferritinaemia. We here report a man with IAD who presented with mild anaemia and unexpected hyperferritinaemia (serum ferritin, 1796\u2009\u00b5g\/L). He had high serum hepcidin and relatively low erythropoietin levels for his anaemia, with hepcidin and ferritin levels reducing with hydrocortisone supplementation. We speculate that low glucocorticoid levels might suppress erythropoiesis and anti-inflammatory activity, resulting in a higher hepcidin level and hyperferritinaemia. The possibility of adrenal insufficiency including IAD should be considered as a differential diagnosis in patients with unexplained hyperferritinaemia.<\/jats:p>","DOI":"10.1136\/bcr-2023-256049","type":"journal-article","created":{"date-parts":[[2023,10,10]],"date-time":"2023-10-10T12:45:44Z","timestamp":1696941944000},"page":"e256049","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Isolated ACTH deficiency: an uncommon cause of hyperferritinaemia"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3080-2341","authenticated-orcid":false,"given":"Atsushi","family":"Isoda","sequence":"first","affiliation":[{"name":"Department of Hematology, Iryo Hojin Hoshi Iin, Maebashi, Japan"},{"name":"Department of Hematology, NHO Shibukawa Medical Center, Shibukawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akio","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Hematology, NHO Shibukawa Medical Center, Shibukawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morio","family":"Matsumoto","sequence":"additional","affiliation":[{"name":"Department of Hematology, NHO Shibukawa Medical Center, Shibukawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morio","family":"Sawamura","sequence":"additional","affiliation":[{"name":"Department of Hematology, NHO Shibukawa Medical Center, Shibukawa, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,10,10]]},"reference":[{"key":"2025082800262329000_16.10.e256049.1","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-006-0408-5"},{"key":"2025082800262329000_16.10.e256049.2","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3181db6b7a"},{"key":"2025082800262329000_16.10.e256049.3","doi-asserted-by":"publisher","DOI":"10.1080\/10245332.2018.1488569"},{"key":"2025082800262329000_16.10.e256049.4","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqw053"},{"key":"2025082800262329000_16.10.e256049.5","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1007\/s00277-017-3072-0","article-title":"Elevated serum Ferritin is not specific for Hemophagocytic Lymphohistiocytosis","volume":"96","author":"Otrock","year":"2017","journal-title":"Ann Hematol"},{"key":"2025082800262329000_16.10.e256049.6","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21423"},{"key":"2025082800262329000_16.10.e256049.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(99)80015-1"},{"key":"2025082800262329000_16.10.e256049.8","doi-asserted-by":"crossref","first-page":"184","DOI":"10.4158\/EP.7.3.184","article-title":"Liver involvement and abnormal iron variables in Undiagnosed Addison\u2019s disease","volume":"7","author":"Rizvi","year":"2001","journal-title":"Endocr Pract"},{"key":"2025082800262329000_16.10.e256049.9","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1182\/blood.V3.12.1342.1342","article-title":"The effect of Endocrinopathies on the blood","volume":"3","author":"Daughaday","year":"1948","journal-title":"Blood"},{"key":"2025082800262329000_16.10.e256049.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.1.4762.787"},{"key":"2025082800262329000_16.10.e256049.11","first-page":"52","article-title":"Anaemia in Hypopituitarism; treatment with testosterone and Cortisone","volume":"2","author":"Greig","year":"1956","journal-title":"S Afr J Lab Clin Med"},{"key":"2025082800262329000_16.10.e256049.12","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V94.2.550"},{"key":"2025082800262329000_16.10.e256049.13","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/s12185-013-1485-7","article-title":"Distribution of serum erythropoietin levels in lower risk myelodysplastic syndrome cases with anemia","volume":"99","author":"Nakazaki","year":"2014","journal-title":"Int J Hematol"},{"key":"2025082800262329000_16.10.e256049.14","doi-asserted-by":"publisher","DOI":"10.1038\/emboj.2012.125"},{"key":"2025082800262329000_16.10.e256049.15","doi-asserted-by":"publisher","DOI":"10.1172\/JCI63924"},{"key":"2025082800262329000_16.10.e256049.16","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-40-2-211"},{"key":"2025082800262329000_16.10.e256049.17","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1159\/000208233","article-title":"Effect of starvation on the response to erythropoietin in the rat","volume":"52","author":"Naets","year":"1974","journal-title":"Acta Haematol"},{"key":"2025082800262329000_16.10.e256049.18","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1705338114"},{"key":"2025082800262329000_16.10.e256049.19","doi-asserted-by":"publisher","DOI":"10.1172\/JCI200420945"},{"key":"2025082800262329000_16.10.e256049.20","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-12-195651"},{"key":"2025082800262329000_16.10.e256049.21","doi-asserted-by":"crossref","unstructured":"Harbuz MS . 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