Adrenal insufficiency secondary to inappropriate oral administration of topical exogenous steroids presenting with hypercalcaemia.
A 59-year-old Caucasian gentleman presented with malaise, fatigue and proximal muscle weakness. He had history of long-standing roseate psoriasis treated with topical clobetasol propionate (dermovate). On admission, he had significant postural hypotension, and hypercalcaemia. Endocrinological investigation revealed hypercalcaemia, a serum cortisol of <30 nmol/l, a flat short synacthen test and undetectable adrenocorticotropic hormone. He was treated with hydrocortisone. The abrupt withdrawal of the topical steroids by the patient precipitated the addisonian crisis. Further enquiry documented inappropriate oral administration of clobetasol for more than 10 years in addition to prescribed topical usage.
Diabetes & Endocrinology Department, Guy's & St Thomas Hospital, London, United Kingdom. rsbhatti91@hotmail.com
Rahila Sarwar
RS
Bhatti
Michael D
MD
Flynn
D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000150:complications / Q000188:drug therapy; D002990:Clobetasol / Q000008:administration & dosage / Q000009:adverse effects*; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D006934:Hypercalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000188:drug therapy; D012651:Self Medication / Q000009:adverse effects*
D005938:Glucocorticoids; D002990:Clobetasol; D006854:Hydrocortisone