Adrenal crisis while on high-dose steroid treatment: what rheumatologist should consider?
Steroid treatment is commonly recommended for autoimmune disorders in rheumatology practice. While adrenal crisis may occur upon existence of an inducing factor in patients with known or unknown adrenal insufficiency as well as in those with a suppressed hypothalamic-pituitary-adrenal (HPA) axis due to chronic steroid use, addisonian crisis rarely develops in patients on supraphysiological doses of steroid and, when emerged, it might be very difficult to recognize. Here, we present a patient who developed adrenal crisis while receiving high-dose methylprednisolone treatment due to retroperitoneal fibrosis and we also discuss possible mechanisms with a brief literature review.
Division of Rheumatology, Department of Internal Medicine, School of Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey. ducansu@hotmail.com.
Döndü
http://orcid.org/0000-0001-6543-3905
D
Üsküdar Cansu
Division of Endocrinology, Department of Internal Medicine, Eskişehir Yunusemre State Hospital, Eskişehir, Turkey.
Güven Barış
GB
Cansu
Division of Pathology, Eskişehir Osmangazi University, Eskişehir, Turkey.
Deniz
D
Arik
Division of Rheumatology, Department of Internal Medicine, School of Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey.
Cengiz
C
Korkmaz
D000309:Adrenal Insufficiency / Q000139:chemically induced* / Q000503:physiopathology; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000000981:diagnostic imaging / Q000187:drug effects*; D008562:Membrane Glycoproteins; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D017472:Receptors, Interleukin-1; D000072140:Rheumatologists
D005938:Glucocorticoids; D008562:Membrane Glycoproteins; D017472:Receptors, Interleukin-1; C434984:TIRAP protein, human
Adrenal crisis; Corticosteroid therapy; Retroperitoneal fibrosis; Tuberculosis