Secondary adrenal insufficiency after glucocorticosteroid administration in acute spinal cord injury: a case report.

Abstract

CONTEXT/BACKGROUND:

A 61-year-old female with cervical stenosis underwent an elective cervical laminectomy with post-op worsening upper extremity weakness. Over the first 3 weeks post-op, she received two separate courses of intravenous steroids. Two days after cessation of steroids, she presented with non-specific symptoms of adrenal insufficiency (AI). Initial formal diagnostic tests of random cortisol level and 250 µg cosyntropin challenge were non-diagnostic; however, symptoms resolved with the initiation of empiric treatment with hydrocortisone. Ten days later, repeat cosyntropin (adrenocortocotropic hormone stimulation) test confirmed the diagnosis of AI.

FINDINGS:

AI is a potentially life-threatening complication of acute spinal cord injury (ASCI), especially in those receiving steroids acutely. Only three cases have been reported to date of AI occurring in ASCI after steroid treatment. The presenting symptoms can be non-specific (as in this patient) and easily confused with other common sequelae of ASCI such as orthostasis and diffuse weakness. The 250 µg cosyntropin simulation test may not the most sensitive test to diagnose AI in ASCI.

CONCLUSION:

The non-specific presentations and variability of diagnosis criteria make diagnosis more difficult. One microgram cosyntropin simulation test may be more sensitive than higher dose. Clinicians should be aware that AI can be a potential life-threatening complication of ASCI post-steroid treatment. Prompt diagnosis and treatment can reverse symptoms and minimize mortality.

• Authors: Huiqing Yang, Michelle Trbovich, Jeffrey Harrow
• Journal: The journal of spinal cord medicine (J Spinal Cord Med) Vol. 37 Issue 6 Pg. 786-90 (Nov 2014) ISSN: 1079-0268 [Print] England
• PMID: 24969098 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Inflammatory Agents
• Cosyntropin
• Hydrocortisone

Topics

• Adrenal Insufficiency (chemically induced)
• Anti-Inflammatory Agents (adverse effects)
• Cosyntropin (administration & dosage)
• Dose-Response Relationship, Drug
• Female
• Humans
• Hydrocortisone (adverse effects)
• Middle Aged
• Spinal Cord Injuries (drug therapy)
• Time Factors