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Fecal Glucocorticoid Analysis: Non-invasive Adrenal Monitoring in Equids
Published on: April 25, 2016
Secondary Adrenal Insufficiency due to Intra-articular Glucocorticoid Injections
Malgorzata Wojcik1, Anna Ruszala2, Dominika Janus2
1Department of Pediatric and Adolescent Endocrinology, Institute of Pediatrics, Jagiellonian University Medical College, and Children's University Hospital, Krakow, Poland. Correspondence to: Dr Malgorzata Wojcik, Department of Pediatric and Adolescent Endocrinology, Institute of Pediatrics, Jagiellonian University Medical College, Wielicka St. 265 30-663 Krakow, Poland. malgorzata.wojcik@uj.edu.pl.
Background:
The most common cause of hypothalamic-pituitary-adrenal axis suppression is systemic glucocorticoids administration.
Case Characteristics:
A 14-year-old boy with juvenile idiopathic arthritis receiving repeated intra-articular steroids for last 3 years developed fever, fatigue, nausea and abdominal pain. Stimulation with low-dose Synathen revealed low adrenal reserve, suggesting secondary adrenal insufficiency.
Outcome:
Temporary hydrocortisone substitution therapy improved condition.
Message:
Intra-articular steroids may cause potentially life-threatening suppression of the hypothalamic-pituitary-adrenal axis.
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