Abstract

MANAS MARTINEZ, Ana Belén; GOMEZ AGUIRRE, Noelia; PEREZ FERNANDEZ, Leticia  and  MANAS MARTINEZ, Mar. Chronic secondary suprarrenal failure after prolonged corticosteroid treatment. Rev Clin Med Fam [online]. 2021, vol.14, n.3, pp.159-161.  Epub Nov 29, 2021. ISSN 2386-8201.

Glucocorticoids are drugs widely used chronically to treat various autoimmune, haematological conditions and advanced malignancies. Nevertheless, glucocorticoids are considered a common cause of tertiary adrenal insufficiency. Therefore, patients may require glucocorticoid replacement therapy after chronic use of glucocorticoids.

We report the clinical case of a 65-year-old patient on chronic glucocorticoid treatment due to pulmonary sarcoidosis diagnosed in 2012. Despite gradual tapering of treatment once the main disease was in remission, the patient was diagnosed with adrenal insufficiency due to persistent clinical symptoms of intense asthenia and profuse sweating once reactivation of her disease was ruled out.

Adrenal insufficiency should be suspected in every patient on chronic glucocorticoid treatment. Gradual tapering of glucocorticoid treatment over weeks is a common clinical practice that minimizes the risk of adrenal insufficiency but does not eliminate it completely. Determination of basal cortisol at least 18 hours after the last dose of glucocorticoid may be useful to evaluate the pituitary-adrenal axis and safely withdraw glucocorticoid treatment.

Keywords : adrenal insufficiency; glucocorticoid; withdrawal.

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