Secondary Adrenal Insufficiency due to Intra-articular Glucocorticoid Injections
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The most common cause of hypothalamic-pituitary-adrenal axis suppression is systemic glucocorticoids administration.
A 14- year-old boy with juvenile idiopathic arthritis receiving repeated intra-articular steroids for last 3 years developed fever, fatigue, nausea and abdominal pain. Stimulation with lowdose Synathen revealed low adrenal reserve, suggesting secondary adrenal insufficiency.
Temporary hydrocortisone substitution therapy improved condition.
Intra-articular steroids may cause potentially life-threatening suppression of the hypothalamic-pituitary-adrenal axis.
KeywordsAdrenal insufficiency Corticosteroids Fever Juvenile idiopathic arthritis