Poster 67 Turkish Adaptation and Validity of the Work Productivity and Activity Impairment Questionnaire in Ankylosing Spondylitis

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complaints of marked muscle atrophy and weakness in all four extremities leading to impaired mobility. Complaints began after self-injecting triamcinolone acetonide in her face for cosmetic reasons. From April 2012 to February 2013 she injected a total of 3-4 bottles from an unknown source into her cheeks, chin and forehead. In April 2013 she was admitted to an inpatient hospital medicine service for pituitary pan-suppression leading to hypothyroidism, adrenal insufficiency, hypertension and diabetes. She was discharged with outpatient endocrinology follow-up, and was non-compliant with prescribed steroid repletion. Over the subsequent months, she declined functionally and became wheelchair dependent for ambulation. At this time she was admitted to an acute inpatient rehabilitation unit. On admission, the patient had cushingoid features with atrophy of all extremities. Setting: Tertiary Care Teaching Hospital. Results or Clinical Course: The patient was diagnosed with steroid-induced myopathy causing severely impaired mobility, requiring interdisciplinary rehabilitation. Physical and occupational therapy were started at submaximal exertion and gradually increased in intensity. Upon completion of her therapy the patient was noted to have improved strength, ambulation and ADLs. Discussion: Triamcinolone acetonide is a glucocorticoid that is used in many conditions. An injectable suspension of triamcinolone is often used in Rehabilitation for the treatment of inflammatory conditions. High dose or prolonged use of corticosteroids may cause drug-induced adrenocortical suppression. This condition is often reversible but in some severe cases can cause irreparable suppression of the hypothalamic pituitary adrenal axis leading to iatrogenic Cushing’s Syndrome and myopathy. Conclusions: This case illustrates the effects of improper and prolonged use of corticosteroids, which are regularly utilized in medicine. It is imperative that patients be educated on the side effects of steroids.