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Adrenal crisis while on high-dose steroid treatment: what rheumatologist should consider?

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Abstract

Steroid treatment is commonly recommended for autoimmune disorders in rheumatology practice. While adrenal crisis may occur upon existence of an inducing factor in patients with known or unknown adrenal insufficiency as well as in those with a suppressed hypothalamic–pituitary–adrenal (HPA) axis due to chronic steroid use, addisonian crisis rarely develops in patients on supraphysiological doses of steroid and, when emerged, it might be very difficult to recognize. Here, we present a patient who developed adrenal crisis while receiving high-dose methylprednisolone treatment due to retroperitoneal fibrosis and we also discuss possible mechanisms with a brief literature review.

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Authors’ contribution

Study concept and design: DÜC and GBC; analysis and interpretation of data: DÜC and DA; drafting of the manuscript: GBC and DÜC; critical revision of the manuscript for important intellectual content: DÜC, CK and GBC; study supervision: DÜC and CK.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, School of Medicine, Eskişehir Osmangazi University, 26480, Eskişehir, Turkey

    Döndü Üsküdar Cansu & Cengiz Korkmaz

  2. Division of Endocrinology, Department of Internal Medicine, Eskişehir Yunusemre State Hospital, Eskişehir, Turkey

    Güven Barış Cansu

  3. Division of Pathology, Eskişehir Osmangazi University, Eskişehir, Turkey

    Deniz Arik

Authors
  1. Döndü Üsküdar Cansu
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  2. Güven Barış Cansu
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  3. Deniz Arik
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  4. Cengiz Korkmaz
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Correspondence to Döndü Üsküdar Cansu.

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The authors declare that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Üsküdar Cansu, D., Cansu, G.B., Arik, D. et al. Adrenal crisis while on high-dose steroid treatment: what rheumatologist should consider?. Rheumatol Int 37, 657–662 (2017). https://doi.org/10.1007/s00296-016-3591-3

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  • DOI: https://doi.org/10.1007/s00296-016-3591-3

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