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A Case-Based Guide to Clinical EndocrinologyAdrenal Insufficiency

A Case-Based Guide to Clinical Endocrinology: Adrenal Insufficiency Chapter 15 Adrenal Insufficiency Lynn Loriaux Objectives To illustrate a typical presentation of adrenal insufficiency and the dire conse- quences that can accrue to the failure to consider adrenal insufficiency in the dif- ferential diagnosis of unexplained abdominal pain. Case Presentation A 32-year-old woman was admitted to the hospital with increasing joint pain and wheezing. She had a past history of rheumatoid arthritis, chronic leukemia, fibromyalgia, and asthma. Medications included Remicade infusion every 2 months, inhaled bronchodilators, prednisone, 2 mg p.o. t.i.d., and methotrexate 2.5 mg a week. The oral prednisone was stopped and she was given Solumedrol R intravenously, 20 mg q.i.d. for 4 days. She was discharged free of symptoms. Prednisone was not included in the discharge medication list. She was seen in the outpatient clinic 4 days later, feeling her usual self. There is no indication that prednisone was restarted at that time. She was next seen 20 days later, complaining of steady epigastric pain with some tenderness to deep palpation in the right upper quadrant. Blood pressure was 130/98, pulse 100, temperature 37.5 C. A complete blood count (CBC) revealed a white cell count of 42,000 with 53% polymorphonuclear cells (PMNs), and 41% lymphocytes. Serum http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png

A Case-Based Guide to Clinical EndocrinologyAdrenal Insufficiency

Part of the Contemporary Endocrinology™ Book Series
Editors: Davies, Terry F.
Loriaux, Lynn
A Case-Based Guide to Clinical Endocrinology — Jan 1, 2008
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Publisher
Humana Press
Copyright
© Humana Press,Totowa, NJ 2008
ISBN
978-1-58829-815-7
Pages
155 –157
DOI
10.1007/978-1-60327-103-5_15
Publisher site
See Chapter on Publisher Site

Abstract

Chapter 15 Adrenal Insufficiency Lynn Loriaux Objectives To illustrate a typical presentation of adrenal insufficiency and the dire conse- quences that can accrue to the failure to consider adrenal insufficiency in the dif- ferential diagnosis of unexplained abdominal pain. Case Presentation A 32-year-old woman was admitted to the hospital with increasing joint pain and wheezing. She had a past history of rheumatoid arthritis, chronic leukemia, fibromyalgia, and asthma. Medications included Remicade infusion every 2 months, inhaled bronchodilators, prednisone, 2 mg p.o. t.i.d., and methotrexate 2.5 mg a week. The oral prednisone was stopped and she was given Solumedrol R intravenously, 20 mg q.i.d. for 4 days. She was discharged free of symptoms. Prednisone was not included in the discharge medication list. She was seen in the outpatient clinic 4 days later, feeling her usual self. There is no indication that prednisone was restarted at that time. She was next seen 20 days later, complaining of steady epigastric pain with some tenderness to deep palpation in the right upper quadrant. Blood pressure was 130/98, pulse 100, temperature 37.5 C. A complete blood count (CBC) revealed a white cell count of 42,000 with 53% polymorphonuclear cells (PMNs), and 41% lymphocytes. Serum

Published: Jan 1, 2008

Keywords: Adrenal Suppression; Replacement Dose; Chronic Leukemia; Exogenous Glucocorticoid; Mild Metabolic Acidosis

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