Chronic corticosteroid use causing insidious suppression of the hypothalamic-pituitary-adrenal axis with acute decompensation: A case of iatrogenic adrenal insufficiency

Abstract

Glucocorticoids are used to treat many medical conditions commonly encountered in clinical practice; and is associated with many well-known adverse effects. Iatrogenic suppression of the hypothalamic-pituitary-adrenal axis occurs commonly with all forms of corticosteroids and may be easily missed. We present the case of a 62-year-old patient who presented with non-specific symptoms of: malaise, fatigue, anorexia, anaemia, and weight loss following an elective orthopaedic surgery. After receiving packed red cells, the patient did not have significant symptomatic improvement. A short corticotropin stimulation test confirmed hypoadrenalism, and the patient improved following a therapeutic trial of hydrocortisone. It was later discovered that the patient was receiving regular intra-articular corticosteroid for osteoarthritis from a private family practitioner. This case highlights the importance of searching for potential iatrogenic corticosteroid exposure in high risk patients; and having a low index of suspicion for hypoadrenalism in patients with non-specific symptoms that cannot be otherwise explained. Early recognition of hypoadrenalism can be lifesaving, especially during periods of physiological stress.