Steroid use in kidney transplant recipients presented with acute myocardial infarction

Suppression of the hypothalamic-pituitary-adrenal axis due to chronic exogenous steroid use is the most common cause of secondary adrenal insufficiency. Most kidney transplant recipients receive steroid therapy for immunosuppression; they are also at high risk for acute coronary events which can increase their physiological stress. Use of steroids early in the course of acute myocardial infarction (MI) raises concerns about the possibility of an increased risk of aneurysm formation and myocardial rupture. We present six case reports of kidney transplant recipients. Two of these recipients developed adrenal insufficiency after acute anterior MI; the life-threatening situation was successfully managed with corticosteroid administration. Four of these kidney transplant recipients presented with acute anterior MI; in these patients prophylactic steroid therapy prevented adrenal insufficiency, without any complication of the MI. We recommend the use of prophylactic corticosteroids for kidney transplant recipients to prevent adrenal insufficiency in the early course of acute MI.