Adrenal insufficiency secondary to glucocorticoid withdrawal in patients with brain tumor.
BACKGROUND
Glucocorticoids are the main drug used to control vasogenic edema in patients with brain tumor. Rapid GC tapering may not only decompensate intracranial pressure, but also unmask SAI, and some symptoms of SAI can be mistakenly attributable to increased intracranial pressure or side effects of chemotherapy and radiation therapy.


METHODS
The University of Virginia Neuro-Oncology Database was reviewed from February 2002 to January 2006, and 5 neuro-oncology patients with clinical and laboratory evidence of SAI were identified.


RESULTS
In our experience, 1% of neuro-oncology patients treated with GC developed SAI. Symptoms resembled increased intracranial pressure or side effects of antineoplastic treatment.


CONCLUSIONS
A healthy index of suspicion for this complication and use of pharmacologic testing will help avert misattribution of symptoms of SAI and its deleterious consequences.
Da Silva
Arnaldo Neves
AN
Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, PO Box 800432, Charlottesville, VA 22908-0432, USA. arnaldo@virginia.edu <arnaldo@virginia.edu>
Schiff
David
D
D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000188:drug therapy* / Q000209:etiology* / Q000517:prevention & control; D001932:Brain Neoplasms / Q000150:complications* / Q000503:physiopathology; D015984:Causality; D003366:Cosyntropin; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D019586:Intracranial Hypertension / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*
D005938:Glucocorticoids; D003366:Cosyntropin; D000324:Adrenocorticotropic Hormone