We report a case of a 75-year-old female, with a known history of Hashimoto’s disease, who was admitted with anorexia, nausea and vomiting. Laboratory data revealed hyponatremia and hypothyroidism. Despite thyroid hormone replacement with synthetic thyroxine, the patient had persistent hyponatremia. Further investigations revealed secondary adrenal insufficiency but otherwise normal pituitary function, based on a rapid adrenocorticotrophic hormone (ACTH) test as part of a combined anterior pituitary stimulation test. She was diagnosed with isolated ACTH deficiency (IAD) with concomitant Hashimoto’s disease. Adrenal insufficiency should be considered in patients with hypothyroidism and persistent hyponatremia. In patients with Hashimoto’s disease who are found to have concomitant hypoadrenalism, IAD should also be suspected after primary adrenal insufficiency is ruled out.

Fourty-four cases with psychosomatic disease or neurosis were studied during serial immersion in hot sulfate spring for 7 days at Sukawa Spa in Iwate prefecture. Before and after the balneotherapy, blood specimen were taken for endocrinological analysis of plasma catecholamines with use of high-speed liquid chromatography. One, two and three years after balneotherapy, long term prognostic efficacy was evaluated by questionnaire in order to examine the relationship between efficacy and changing pattern of plasma catecholamines.
The results of this study presented that the plasma levels of norepinephrine had decreased during balneotherapy in effective cases (p<0.05). Furthermore, the same changing pattern of plasma norepinephrine was observed in the cases which had improved after long interval. On the otherhand, in non-effective cases and cases with recurrence, the plasma levels of norepinephrine had increased significantly (p<0.05) during balneotherapy.
It was thought that response pattern of plasma catecholamines to serial immersion in hot spring reflected the therapeutic mechanism of balneotherapy, thus it would be an appropriate mediator for evaluating the prognosis.