Adrenal Insufficiency Caused by Chronic Corticosteroid Use, Identified through Medication Therapy Management

To report a case of adrenal insufficiency caused by chronic corticosteroid treatment. This case study describes a 71-year-old Caucasian woman diagnosed with secondary adrenal insufficiency (SAI). She had a long history of multiple medical problems that affected her quality of life. The pharmacist re...

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Bibliographic Details
Published in:	The Senior care pharmacist Vol. 36; no. 1; p. 22
Main Authors:	Chen, Tsuhua Susan, Li, Shilun David
Format:	Journal Article
Language:	English
Published:	United States 01-01-2021
Subjects:	Adrenal Cortex Hormones - adverse effects Adrenal Insufficiency - chemically induced Adrenal Insufficiency - diagnosis Adrenal Insufficiency - drug therapy Aged Female Humans Hypothalamo-Hypophyseal System Medication Therapy Management Pituitary-Adrenal System Quality of Life
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Summary:	To report a case of adrenal insufficiency caused by chronic corticosteroid treatment. This case study describes a 71-year-old Caucasian woman diagnosed with secondary adrenal insufficiency (SAI). She had a long history of multiple medical problems that affected her quality of life. The pharmacist reviewed 18 years (2001-2018) of medical records, including her corticosteroid usage history. The patient had been receiving chronic medium-high dose inhaled corticosteroids for asthma, with intermittent oral prednisone for exacerbations. The pharmacist suspected a possible SAI or tertiary adrenal insufficiency (TAI) caused by hypothalamic pituitary adrenal axis suppression induced by chronic corticosteroid use. After discussions with the patient's primary care physician and a screening adrenal function test, the patient was referred to an endocrinologist, and the diagnosis was confirmed. Low-dose hydrocortisone (<30 mg daily) was prescribed; the patient had improvements in mood, skin hyperpigmentation, and asthma symptoms, which eliminated the routine visits to the emergency room/clinic during the winter season. The case illustrated the benefits of utilizing a pharmacist's expertise. A consultant pharmacist can identify an underdiagnosed and rare condition, corticosteroid-induced adrenal insufficiency, through comprehensive medication review in a community medication therapy management service setting.
ISSN:	2639-9636
DOI:	10.4140/TCP.n.2021.22