Acute adrenal crisis in a patient treated with intraarticular steroid therapy.
Intraarticular therapy with corticosteroids can cause systemic effects such as decreased concentration of plasma cortisol, but whether this might place a patient at risk from stress induced acute adrenal failure is not known. We describe a patient who presented with lethargy, hyponatremia, and then with acute abdomen. The diagnosis of acute adrenal crisis was related to suppression of the hypothalamic-pituitary-adrenal axis by intraarticular use of corticosteroid. This was confirmed by a low basal cortisol concentration and by a short Synacthen test that elicited an increase in plasma cortisol concentration from 36 to 481 nmol/l. Within 24 h of receiving 37.5 mg of hydrocortisone, the patient rapidly improved.
Wicki
J
J
Medical Clinic I, Department of Surgery, Geneva University Hospital, Switzerland. jwicki@hotmail.com
Droz
M
M
Cirafici
L
L
Vallotton
M B
MB
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000307:Adrenal Gland Diseases / Q000139:chemically induced* / Q000503:physiopathology; D000368:Aged; D000369:Aged, 80 and over; D002805:Chondrocalcinosis / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D007717:Knee / Q000473:pathology
D000305:Adrenal Cortex Hormones