Adrenal insufficiency secondary to glucocorticoid use: Case report

Abstract

Background: Secondary Cushing’s syndrome due to chronic use of exogenous corticosteroids is an endocrine disorder caused by prolonged exposure to these drugs, which are commonly used to treat various inflammatory and autoimmune diseases. One of its most serious complications is secondary adrenal insufficiency, which can occur following corticosteroid withdrawal syndrome (CWS). This syndrome arises when glucocorticoids are abruptly discontinued, leading to suppression of the hypothalamic-pituitary-adrenal (HPA) axis and, consequently, an acute reduction in endogenous cortisol production, potentially triggering an adrenal crisis.

Purpose: Provide information on the risks associated with the indiscriminate use of corticosteroids, their adverse health effects due to prolonged use, and the consequences of abruptly discontinuing these medications.

Case presentation: A patient who used glucocorticoids for a long time to manage chronic pain, subsequently developed exogenous Cushing's syndrome. After abrupt discontinuation of these medications, suppression of the HPA axis was evident and, consequently, AI.

Discussion and conclusion: It is estimated that Cushing’s syndrome due to exogenous corticosteroid use accounts for 70-90% of cases. Abrupt withdrawal of these drugs may lead to adrenal crisis secondary to corticosteroid withdrawal syndrome. In Colombia, the easy availability of glucocorticoids favors their inappropriate use; therefore, diagnosis should rely on a thorough medical history and laboratory evaluation when clinically suspected.