Transient Adrenal Insufficiency Research Articles

Gabapentin-Induced Adrenal Insufficiency: The Hypothalamic-Pituitary-Adrenal Axis Stress Misresponse and Risk of Infection: A Case Report and Literature Review.

This literature review, in light of the presented case report, explores the complex interplay between gabapentin (GBP), a gamma-aminobutyric acid (GABA) analog, and the hypothalamic-pituitary-adrenal (HPA) axis in patients undergoing major surgical procedures. It specifically investigates the potential impact of GBP on cortisol levels, stress responses, and infection risk, illustrated by a detailed clinical case. This review combines a comprehensive literature search with a case report of a 17-year-old male with osteosarcoma who experienced transient adrenal insufficiency and infections while receiving GBP. The case is analyzed in the context of the existing literature on GBP and the HPA axis. The findings highlight the intricate relationship between GBP use, adrenal insufficiency, and infection susceptibility. It underscores the need for further research and clinical vigilance when prescribing GBP to patients with underlying medical conditions, particularly in the context of major surgical procedures. The review underscores the need for further research and clinical vigilance when prescribing GBP, particularly in perioperative settings. In conclusion, GBP's effects on the HPA axis and immune responses are complex and multifaceted. Clinicians should exercise caution when prescribing GBP, especially for patients with underlying conditions undergoing major surgery. Further research is needed to elucidate the mechanisms of GBP's influence on cortisol levels and stress responses.

Giant left pheochromocytoma with vascular anomalies and pelvic horseshoe kidney: a case report

BackgroundPheochromocytoma is a neuroendocrine tumor, and its treatment is dependent on surgical resection. Due to the wide availability of cross-sectional imaging, pheochromocytomas are commonly seen as small tumors less than 10 cm in size and are mostly treated with minimally invasive surgery. Their concomitant presence with horseshoe kidney or other anatomical and vascular anomalies is rare. Herein, we present a surgically complex giant pheochromocytoma case who underwent an open left radical adrenalectomy.Case presentationA 41-year-old Hispanic female presented with a 12 × 8 cm left hypervascular adrenal mass, pelvic horseshoe kidney, and severely dilated large left retro-aortic renal vein which branched into a left adrenal vein, congested left ovarian vein, and left uterine plexus. She was managed with insulin and metformin for uncontrolled diabetes with an A1c level of 9% and doxazosin for persistent hypertension. Clinical diagnosis of pheochromocytoma was confirmed with elevated urine and serum metanephrine and normetanephrine. The pre-operative ACTH was within normal range with a normal dexamethasone suppression test and 24-hour urine free cortisol. The adrenalectomy of the highly aggressive adrenal mass was performed via open approach to obtain adequate surgical exposure. Due to the large size of the tumor and its significant involvement with multiple adjacent structures, coordination with multiple surgical teams and close hemodynamic monitoring by anesthesiology was required for successful patient outcomes including preservation of blood supply to the pelvic horseshoe kidney. The histopathological diagnosis was pheochromocytoma with negative surgical margins. The patient was followed at 1, 4, 12, and 24 weeks postoperatively. She had a normal postoperative eGFR and was able to discontinue antihypertensive and antidiabetic medications at four weeks. She had transient adrenal insufficiency, which resolved at five months. The horseshoe kidney was intact except for a minimal area of hypo-enhancement in the left superior renal moiety due to infarction, which was significantly improved at six months.ConclusionOur patient had a giant pheochromocytoma with anatomical variations complicating an already surgically challenging procedure. Nonetheless, with multiple provider collaboration, detailed pre-operative surgical planning, and meticulous perioperative monitoring, radical resection of the giant pheochromocytoma was safe and feasible with successful postoperative outcomes.

Hypothyroidism and transient adrenal insufficiency after nivolumab treatment in a renal cell carcinoma woman

Hypothyroidism and transient adrenal insufficiency after nivolumab treatment in a renal cell carcinoma woman

Hyponatremia due to adrenal insufficiency after a Mamushi bite: a case report

BackgroundMamushi bites are the most common venomous snake bites in Japan, with known complications including rhabdomyolysis and acute kidney injury; however, adrenal insufficiency as a result of snake bites has not been previously reported. We report a case of empty sella with transient adrenal insufficiency during hospitalization for a Mamushi bite.Case presentationAn 84-year-old man was admitted to our hospital with a Mamushi bite on the right fifth finger. Serum sodium (Na) level remained in the normal range. On the ninth day of admission, he developed hyponatremia, with a serum Na level of 114 mEq/L and serum cortisol level of 4.0 μg/dL (reference value 4.5–21.1 μg/dL). His serum Na level was restored within the normal range after administration of corticosteroids with 3% NaCl solution. Both rapid adrenocorticotrophin and corticotropin-releasing hormone loading tests showed low cortisol response. Based on the results of the hormone loading tests, a diagnosis of pituitary adrenal insufficiency was made. Contrast-enhanced pituitary magnetic resonance imaging (MRI) showed primary empty sella. After discontinuation of corticosteroids, the hyponatremia did not recur, and the patient was discharged on the 24th day of hospitalization. After discharge, the patient visited an outpatient clinic, but hyponatremia recurrence was not observed.ConclusionsThis is the first report of hyponatremia due to pituitary adrenal insufficiency during hospitalization for a Mamushi bite in a patient with empty sella. When hyponatremia occurs during hospitalization for a Mamushi bite, cortisol measurement, hormone loading test, and head MRI should be performed to search for pituitary lesions because of the possibility of adrenal insufficiency caused by snake venom.

THU016 Hiding In Plain Sight: Florid Cushing’s Disease Presenting As A Severe Extremity Cellulitis

Abstract Disclosure: C.M. Godar: None. E.B. Noble: None. N.O. Vietor: None. T.S. Knee: None. Background: Cushing’s syndrome may rarely present as an emergency known as Florid Cushing’s Syndrome. Patients can exhibit severe hyperglycemia, hypertension, hypokalemia, infections, and hypercoagulability. Cushing’s syndrome is a rare disease, and the constellation of clinical features can be overlooked if clinicians are not aware of the manifestations of hypercortisolism. We present the case of a patient with Cushing’s syndrome that went unrecognized with life-threatening sequelae. Case presentation: A 52-year-old woman with well-controlled type 2 diabetes and hypertension was admitted to the hospital for severe left lower extremity cellulitis. Prior to hospitalization she had noted rapid weight gain, fatigue, weakness, mental clouding, and moodiness. She was admitted for antibiotics and surgical debridement. The infection persisted despite broad spectrum antibiotics, multiple surgical debridements, and skin grafting. She became bacteremic, and extremity amputation was considered. She additionally developed hypertensive emergency, refractory hypokalemia, and hyperglycemia to 396 mg/dL. Exam was notable for facial plethora, supraclavicular fullness, dorsocervical fat pad, and violaceous abdominal striae. Cushing’s Syndrome was suspected, and labs revealed a significantly elevated random serum cortisol of 60.5mcg/dL (Ref 6.2-19.4), significantly elevated 24H urine cortisol of 2157mcg/24H (Ref 0-50), and ACTH elevated to 81.8pg/mL (Ref 7.2-63.3) that confirmed Cushing’s Disease. MRI sella and octreotide scans did not localize a lesion. Inpatient therapy included multiple antihypertensive agents, insulin drip, aggressive potassium repletion, and initiation of ketoconazole to reduce cortisol levels. Ketoconazole was maximally dosed and she underwent surgical exploration and removal of a small pituitary microadenoma. Following surgery, she developed transient adrenal insufficiency requiring hydrocortisone and she no longer required antihypertensives, insulin, or potassium therapy. Follow up 7 years later has revealed no recurrence of Cushing’s Disease. Discussion: Cushing’s Syndrome may present with a variety of clinical features and rarely may present as a medical emergency. Delay in diagnosis can lead to Florid Cushing’s Syndrome which carries high risk for morbidity and mortality. This case illustrates the need for clinician awareness of the features of Cushing’s Syndrome: hypertension, hyperglycemia, rapid weight gain, cushingoid exam features, hypokalemia, hirsutism, virilization, infection, and/or hypercoagulable state. Severe hypercortisolism was responsible for this patient’s refractory infection, and if not controlled, she likely would have endured a lower extremity amputation. Rapid detection with elevated random serum and/or urine cortisol and treatment with a cortisol-lowering agent is critical and lifesaving. Presentation: Thursday, June 15, 2023

Transient Adrenal Insufficiency Following Pfizer/BioNTech Coronavirus Disease-2019 Vaccine Overdose

Transient Adrenal Insufficiency Following Pfizer/BioNTech Coronavirus Disease-2019 Vaccine Overdose

Abstract #1403717: Thyro-Adrenal Insufficiency in Severe Hypothyroidism – A Clinical Mirage? A Cross-Sectional, Propensity-Matched Case-Control Study from a Tertiary Care Centre Kalaburgi, Kalyana Karnataka

Assessment of 8:00 AM cortisol levels and predict risk of adrenal insufficiency in treatment naïve severe hypothyroidism. A cross-sectional, observational, case-control study was conducted at tertiary care teaching hospital in Kalaburagi, Kalyana Karnataka, South India between January 2017 and March 2020. We included 71 consecutive adult individuals in the age group of 18-50 years of either gender, referred to the Division of Diabetes and Endocrinology, Department of Internal Medicine. All the cases were treatment naïve, diagnosed with severe hypothyroidism defined as TSH levels > 100 μIU/ml. We excluded patients with a past history of Grave’s disease, those who had ever used anti-thyroid drugs, those who had taken radioactive iodine, received steroids for any reasons, patients with a history of thyroidectomy, pre-existing pituitary or adrenal disorders, pregnancy, patients on oral contraceptives and patients with any underlying malignancies. The control population included individuals without any known thyroid disorder or any other comorbid conditions that are known to affect the function of hypothalmo-pituitary-adrenal axis. The controls were age and gender-matched. We used SAS 9.4 version software to analyze the data. T3, T4, and cortisol have been categorized and summarized descriptively with the actual collected values. Continuous variables are presented with mean and standard deviation. Categorical parameters are summarized with counts and percentages. Correlation coefficients among the T3, T4, and cortisol were generated for the overall population. Seventy-one cases of severe hypothyroidism (TSH >100 mIU/L) were compared with age and gender-matched controls (n=40). The mean age of the patients was 30.0±9.0 years and 88.7% were females. Serum cortisol levels were significantly lower in cases than in controls (8.6±4.2 vs. 16.0±2.22 μg/dl respectively, p<0.0001). Six (8.5%) cases were identified with adrenal insufficiency. After propensity matching, T3 (20.32±16.94 vs. 39.33±38.92 ng/dl, p=0.018) and T4 (0.81±0.55 vs. 1.93±1.17 μg/dl, p=0.005) levels were comparatively lower in adrenal insufficiency cases than those without adrenal insufficiency. Serum T3 (r = -0.243, p=0.041) but not T4 (r = -0.103, p=0.391) had a significant negative correlation with serum cortisol levels. Transient adrenal insufficiency can be seen in treatment naïve severe hypothyroidism. In our cohort, the incidence of adrenal insufficiency was 8.5%. An apt clinical vigilance is needed to identify adrenal insufficiency in such patients. Further studies are needed to understand the implications of severe hypothyroidism with adrenal insufficiency. A short synaecthien test may be needed in with low cortisol at diagnosis of severe hypothyroidism.

A MEN-2A Case Developing Transient Adrenal Insufficiency after Unilateral Pheochromocytoma Surgery

A MEN-2A Case Developing Transient Adrenal Insufficiency after Unilateral Pheochromocytoma Surgery

Transient adrenal insufficiency following treatment of rheumatoid arthritis with intramuscular methylprednisolone acetate

An 82-year-old woman presented with dizziness, a fall, and pubic fractures. She had resting severe hypertension, with marked orthostatic hypotension. She was recently diagnosed with cyclic citrullinated peptide (+) rheumatoid arthritis. She had received 120 mg intramuscular methylprednisolone (Depo-Medrone®) eight months prior, and a second dose a day preceding hospitalisation. Two days into the admission, her Glasgow coma scale (GCS) score dropped acutely from 15/15 (E4;V5;M6) to 3/15 (E1;V1;M1). The initial differential diagnoses were: an acute stroke (a total anterior circulation syndrome-TACS or brainstem stroke), opiate toxicity (fracture pains), and possible unwitnessed seizure (in a post-ictal state). Urgent computerised tomography (CT) brain was unremarkable. She had an acute-on-chronic hyponatraemia (nadir 121 mmol/L) while on long-term proton pump inhibitor therapy, and hyperkalaemia (peak 5.8 mmol/L). Initial management included intravenous (IV) naloxone, fluids and diazepam with poor clinical response. Due to persistent low GCS, the admitting team were concerned about a potentially guarded prognosis. However, based on the history of recent high dose steroid injections, plus the evolving clinical picture and abnormal biochemistry, empirical treatment was started (IV hydrocortisone 100 mg QDS and 0.9% saline infusion) for possible adrenal insufficiency. An ‘add-on’ request for random serum cortisol was made to her admission bloods, and returned low (33 nmol/L). With treatment, her GCS improved rapidly from 3/15 to 15/15. A subsequent planned short synacthen test was abnormal (cortisol level pre-synacthen 100; 30min post-synacthen 340), suggestive of adrenal insufficiency. Following consultation with endocrinology, she was maintained on oral hydrocortisone 10 mg (am)/5 mg(teatime) with sustained clinical improvement.

Inhibition of CYP3A7 DHEA-S Oxidation by Lopinavir and Ritonavir: An Alternative Mechanism for Adrenal Impairment in HIV Antiretroviral-Treated Neonates

Prophylactic antiretroviral therapy (ART) in HIV infected pregnant mothers and their newborns can dramatically reduce mother-to-child viral transmission and seroconversion in the neonate. The ritonavir-boosted lopinavir regimen, known as Kaletra, has been associated with premature birth and transient adrenal insufficiency in newborns, accompanied by increases in plasma dehydroepiandrosterone 3-sulfate (DHEA-S). In the fetus and neonates, cytochrome P450 CYP3A7 is responsible for the metabolism of DHEA-S into 16α-hydroxy DHEA-S, which plays a critical role in growth and development. In order to determine if CYP3A7 inhibition could lead to the adverse outcomes associated with Kaletra therapy, we conducted in vitro metabolic studies to determine the extent and mechanism of CYP3A7 inhibition by both ritonavir and lopinavir and the relative intrinsic clearance of lopinavir with and without ritonavir in both neonatal and adult human liver microsomes (HLMs). We identified ritonavir as a potent inhibitor of CYP3A7 oxidation of DHEA-S (IC50 = 0.0514 μM), while lopinavir is a much weaker inhibitor (IC50 = 5.88 μM). Furthermore, ritonavir is a time-dependent inhibitor of CYP3A7 with a KI of 0.392 μM and a kinact of 0.119 min–1, illustrating the potential for CYP3A mediated drug–drug interactions with Kaletra. The clearance rate of lopinavir in neonatal HLMs was much slower and comparable to the rate observed in adult HLMs in the presence of ritonavir, suggesting that the addition of ritonavir in the cocktail therapy may not be necessary to maintain effective concentrations of lopinavir in neonates. Our results suggest that several of the observed adverse outcomes of Kaletra therapy may be due to the direct inhibition of CYP3A7 by ritonavir and that the necessity for the inclusion of this drug in the therapy may be obviated by the lower rate of lopinavir clearance in the neonatal liver. These results may lead to a reconsideration of the use of ritonavir in neonatal antiretroviral therapy.

Anesthetic Induction With Etomidate in Cardiac Surgical Patients: A PRISMA-Compliant Systematic Review and Meta-Analysis

This meta-analysis aimed to systematically review the effects of etomidate (ETM) during anesthetic induction on patients undergoing cardiac surgery. Systematic review and meta-analysis. Operating room. Patients undergoing cardiac surgery. ETM or control drugs. PubMed, Cochrane Library, OVID, and EMBASE were searched through August 31, 2020. Primary outcomes included hemodynamic profiles and stress responses. Secondary outcomes included morbidity, mortality, and postoperative recovery. For continuous/dichotomous variables, treatment effects were calculated as weighted mean difference (WMD)/odds ratio (OR) and 95% confidence interval (CI). A database search yielded 18 randomized controlled trials including 1,241 patients. The present meta-analysis demonstrated that ETM-anesthetized patients had lower heart rates (WMD, -3.31; 95% CI -5.43 to -1.19; p = 0.002), higher blood pressures (systolic blood pressure: WMD, 12.02; 95% CI 6.24 to 17.80; p < 0.0001; diastolic blood pressure: WMD, 5.23; 95% CI 2.39 to 8.08; p = 0.0003; mean arterial pressure (MAP): WMD, 8.64; 95% CI 5.85 to 11.43; p < 0.00001), less requirement for vasopressor (OR, 0.26; 95% CI 0.15 to 0.44; p < 0.00001), and more nitroglycerin usage (OR, 14.89; 95% CI 4.92 to 45.08; p < 0.00001) during anesthetic induction. Current meta-analysis also demonstrated that single-dose ETM lowered cortisol levels transiently and did not have a significant effect on endogenous norepinephrine and epinephrine levels and was not associated with increased postoperative inotrope and/or vasopressor requirement. Additionally, the meta-analysis suggested that ETM anesthesia was associated with neither increased mortality nor morbidity, except a higher incidence of transient adrenal insufficiency in ETM recipients. The present meta-analysis suggested that single-dose ETM during anesthetic induction could be associated with more stable hemodynamics, transient and reversible lower cortisol levels, and a higher adrenal insufficiency incidence, but not worse outcomes in cardiac surgical patients.

SUN-214 A Novel Glucocorticoid Receptor Antagonist (CORT113176) Reveals Unique Developmental and Tissue-Specific Effects in a Neonatal Rat Model of Human Prematurity

Premature birth is a major public health problem worldwide and can lead to transient adrenal insufficiency1,2. The stress of premature birth includes the inability to control blood glucose and maintain normal oxygenation leading to hypoxia3. Corticosteroid administration enhances surfactant production and improves oxygenation in preterm humans. However, corticosteroids can also have negative consequences4,5. We have validated a rat model of separation and hypoxia on post-natal day (PD) 2 that emulates the stress and treatment of hypoxia in the preterm human infant6,7. We hypothesized that the role of endogenous glucocorticoids in our neonatal rat model of preterm birth can be evaluated using the novel selective glucocorticoid receptor (GR) antagonist CORT113176 (Corcept) which is devoid of progesterone receptor effects8. Pups (PD 2, 8, or 15; N=6–8 per treatment/timepoint) were given CORT113176 (60 mg/kg IP) or vehicle, then placed into chambers in room air with mild warming to prevent hypothermia due to maternal separation. 60 min later, one group of pups was euthanized and trunk blood collected (baseline). The remaining pups were exposed to hypoxia (8% O2) or normoxia (time control) for 30 or 60 min at which times trunk blood was collected for the measurement of plasma glucose, insulin, ACTH, and corticosterone. Plasma ACTH, corticosterone, and insulin were measured by immunoassay. Glucose was measured by glucose oxidase method and insulin sensitivity calculated (HOMA-IR). Organs were frozen (brain, pituitary, adrenal glands, kidney, liver, muscle, fat) for future assessment of tissue-specific glucocorticoid-sensitive gene expression. In PD2 rats, basal and hypoxia-stimulated plasma ACTH and corticosterone were lower and basal HOMA-IR greater with CORT113176 pretreatment suggesting (unexpectedly) glucocorticoid agonist activity. In PD8 and PD15 rats, basal and hypoxia-stimulated plasma ACTH and corticosterone were augmented after CORT113176 pretreatment demonstrating classic antagonist activity. However, in PD8 rats, CORT113176 effects were tissue-specific acting as a classic antagonist on the HPA-axis, but as an agonist on whole-body insulin resistance. The differential effects of CORT113176 based on age and target tissue indicate that GR regulation changes in early development in our animal model of human prematurity. These findings may have significant implications in the treatment of hypoxia and transient adrenal insufficiency in the preterm infant1,2 as well as give insight into the nuances of the control of glucocorticoid receptor function. 1Lancet 392:1923–1994, 2018 2Curr Opin Endocrinol Diabetes Obes 17:8–12, 2010 3Compr Ther 13:14–19, 1987 4Int Immunopharmacol 66:242–250, 2019 5J Neuroendocrinol 27:468–480, 2015 6Am J Physiol 300:R708-715, 2011 7Am J Physiol 302:R627-R633, 2012 8Med Chem Lett 25:5720−5725, 2015

Transient adrenal insufficiency in a patient with an insulinoma

Transient adrenal insufficiency in a patient with an insulinoma

Adrenal venous sampling in patients with ACTH-independent hypercortisolism

PurposeTo study the usefulness of adrenal venous sampling (AVS) in distinguishing unilateral from bilateral cortisol production in patients with ACTH-independent hypercortisolism and bilateral adrenal lesions, or morphologically normal adrenal glands.MethodsA retrospective analysis of ten consecutive patients with ACTH-independent hypercortisolism who underwent AVS at our institution between 2009 and 2017. Unilateral dominant cortisol production was defined as a side-to-side cortisol/aldosterone lateralization ratio >2.ResultsFour of ten patients had overt Cushing’s syndrome. Of these, two had bilateral adrenal lesions on computed tomography and two had normal adrenal glands. One of the two patients with bilateral adrenal lesions had, based on the AVS, a unilateral dominant cortisol production. Following unilateral adrenalectomy the patient developed adrenal insufficiency. The other three patients were considered to have bilateral cortisol production and underwent bilateral adrenalectomy. Six patients had a mild autonomous cortisol secretion and bilateral adrenal lesions. Based on AVS, one patient was considered to have unilateral dominant cortisol production, underwent unilateral adrenalectomy and developed transient adrenal insufficiency postoperatively.ConclusionsAVS may contribute to appropriate treatment in patients with ACTH-independent hypercortisolism and bilateral adrenal lesions. In our series, AVS was helpful in the decision-making of two out of ten patients, avoiding chronic treatment with steroidogenesis inhibitors, or inappropriate bilateral adrenalectomy.

HIV Drug Efavirenz Inhibits CYP21A2 Activity with Possible Clinical Implications

Background: The HIV drugs lopinavir and ritonavir have recently been reported to cause transient adrenal insufficiency in preterm newborns. We, therefore, considered HIV drugs as a cause of transiently elevated 17-hydroxyprogesterone (17OHP) levels in a neonatal screening test for congenital adrenal hyperplasia in a preterm girl exposed to zidovudine, efavirenz, tenofovir, and emtricitabine. Objective: So far, HIV drugs have not been tested for their effect on steroidogenesis and the steroidogenic enzyme activity of CYP21A2 specifically in an in vitro system. Methods: We tested the effect of efavirenz, tenofovir, emtricitabine, and zidovudine on steroidogenesis of human adrenal H295R cells. Cells were treated with the drugs at different concentrations including concentrations in therapeutic use. The effect on CYP21A2 activity was assessed by testing the conversion of radiolabeled 17OHP to 11-deoxycortisol. Cell viability was tested by an MTT assay. In addition, recombinant human CYP21A2 protein was used to assess direct drug effects on CYP21A2 activity. Results: We observed significantly decreased CYP21A2 activity in both in vitro testing systems after treatment with efavirenz at therapeutic concentrations. Moreover, efavirenz affected cell viability. By contrast, the other test drugs did not affect steroidogenesis. Follow-up of our patient revealed elevated 17OHP and androgen levels during the first weeks of life, but values normalized spontaneously. Genetic testing for CYP21A2 mutations was negative. Thus, it remains unsettled whether the transient 17OHP elevation in this baby was due to a drug effect. Conclusion: The HIV drug efavirenz inhibits CYP21A2 activity in vitro through direct interaction with enzyme catalysis at therapeutic concentrations. This may have clinical implications for HIV treatment in children and adults. However, so far, clinical data are scarce, and further studies are needed to be able to draw clinical conclusions.

Mitotane (op'DDD) restores growth and puberty in nine children with Cushing's disease.

To investigate whether low-dose mitotane (up to 2 g/day) could be a temporary therapeutic alternative to transsphenoidal surgery (TSS) in pediatric Cushing’s disease (CD). Twenty-eight patients with CD aged 12.2 years (± 2.2) were referred to our center. We compared nine patients treated with mitotane alone for at least 6 months to 13 patients cured after surgery. Primary outcomes were changes in growth velocity, BMI and pubertal development. The following results were obtained: (1) Mitotane improved growth velocity z-scores (−3.8 (±0.3) vs −0.2 (±0.6)), BMI z-scores (2.1 (±0.5) vs 1.2 (±0.5) s.d.) and pubertal development. After 1 year on mitotane, the mean BMI z-score was not significantly different in both groups of patients. (2) Control of cortisol secretion was delayed and inconsistent with mitotane used as monotherapy. (3) Side effects were similar to those previously reported, reversible and dose dependent: unspecific digestive symptoms, concentration or memory problems, physical exhaustion, adrenal insufficiency and hepatitis. (4) In one patient, progressive growth of a pituitary adenoma was observed over 40 months of mitotane treatment, allowing selective adenomectomy by TSS. In conclusions, low-dose mitotane can restore growth velocity and pubertal development and decrease BMI in children with CD, even without optimal control of cortisol secretion. It may promote pituitary tumor growth thus facilitating second-line TSS. However, given its possibly life-threatening side effects (transient adrenal insufficiency and hepatitis), and in the absence of any reliable follow-up procedures, this therapy may be difficult to manage and should always be initiated and monitored by specialized teams.

Transient adrenal insufficiency in diffuse large B cell lymphoma patients after chemotherapy with short-course, high-dose corticosteroids

Data on the rate of adrenal insufficiency (AI) in patients receiving short-course and high-dose corticosteroids are limited. In this study, we aimed to determine the incidence of AI in newly diagnosed, diffuse large B cell lymphoma (DLBCL) patients after receiving rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone [or prednisolone] (R-CHOP/CHOP) regimen. We enrolled newly diagnosed DLBCL patients who were scheduled to receive 6–8 cycles of R-CHOP/CHOP regimen. One-microgram adrenocorticotropic hormone (ACTH) stimulation tests were performed at the study entry and 3 weeks after each cycle of chemotherapy (CMT). AI was defined by a peak-stimulated serum cortisol of less than 18 μg/dL. For patients who had AI after completing a course of CMT, 1-μg ACTH stimulation tests were carried out at 60 and 90 days after the last CMT cycle to assess the duration of hypothalamic-pituitary-adrenal (HPA) axis recovery. Ten DLBCL patients were included in this study, with a total of 84 1-μg ACTH stimulation tests. Their mean age was 52 years. AI occurred in 3 out of the 10 patients (30%). The first occurrence of AI was after the third CMT cycle, and the incidence was highest after the fifth cycle. Adrenal function recovered completely 3 to 5 weeks after completing the course of CMT, except for 1 patient, whose HPA axis suppression persisted 90 days after the last CMT cycle. Receiver operating characteristic (ROC) analysis revealed that a basal cortisol level of < 8.7 μg/dL was predictive of AI, with a sensitivity and specificity of 80% and 72.2%, respectively. Transient HPA axis suppression can occur in DLBCL patients receiving R-CHOP/CHOP regimen. We strongly encourage careful observation and examination for potential adrenal insufficiency in such patients, particularly after the fifth cycle of chemotherapy.

Transient adrenal insufficiency secondary to chronic opioid drug therapy

Transient adrenal insufficiency secondary to chronic opioid drug therapy

Transient adrenal Insufficiency and post-treatment bradycardia in scrub typhus - a case report

Transient adrenal Insufficiency and post-treatment bradycardia in scrub typhus - a case report

Triple Phase Response of Transient Hyponatremia or Secondary Adrenal Insufficiency? A Case Report

Triple Phase Response of Transient Hyponatremia or Secondary Adrenal Insufficiency? A Case Report