Case history
Case history
A 55-year-old man is seen urgently at the clinic for weakness, nausea, and vomiting. He has a history of chronic obstructive pulmonary disease, with previous admissions to the hospital for exacerbations necessitating systemic glucocorticoids, including twice in the past month alone. During these admissions, he recalls receiving intravenous glucocorticoids that are later switched to an oral formulation. He was last discharged 3 weeks ago, but his take-home oral glucocorticoid doses were higher and the tapering schedule longer than usual for him. He felt his breathing had improved but that he was gaining weight, so he stopped taking the pills 1 week ago. On exam, his blood pressure is 86/58 mmHg, pulse rate is 103 beats/minute, and he has moon facies.
Other presentations
Patients may or may not appear cushingoid. When the inciting medication or condition is suddenly removed, secondary adrenal insufficiency occurs. Signs and symptoms of corticosteroid-induced adrenal suppression may be subtle or overt. Symptoms range from vague fatigue and nausea to those of adrenal crisis (e.g., hypotension).
The nonspecific symptoms of adrenal suppression in children are similar to those seen in adults; however, children may also exhibit growth failure and hypoglycemia.[2]
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