title: Secondary adrenal insufficiency after intrathecal steroid administration.
abstract: A 38-year-old man developed secondary adrenal insufficiency as a consequence of intrathecal methylprednisolone administration. Evidence in support of this diagnosis included an absent plasma cortisol response to insulin-induced hypoglycemia, an inadequate adrenal response to exogenous corticotropin stimulation, a typical delayed response to prolonged corticotropin infusion over 3 days, and the findings of an elevated level of prednisolone in the cerebrospinal fluid a full 2 months after its administration. It is therefore recommended that patients receiving intrathecal steroids be carefully observed for the possible development of secondary adrenal insufficiency.
mesh_terms: D000309:Adrenal Insufficiency / Q000139:chemically induced*; D000324:Adrenocorticotropic Hormone; D000328:Adult; D003692:Delayed-Action Preparations; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D007278:Injections, Spinal; D007328:Insulin; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D010900:Pituitary Diseases / Q000139:chemically induced*; D010913:Pituitary-Adrenal System / Q000503:physiopathology
chemical_list: D003692:Delayed-Action Preparations; D007328:Insulin; D000324:Adrenocorticotropic Hormone; D008775:Methylprednisolone