33 research outputs found
Relative adrenal insufficiency in post-transplant lymphoproliferative disorder.
Post-transplant lymphoproliferative disorder is treated with rapid decrement of immunosuppressive therapy. This cannot be achieved with ease in patients on long-term glucocorticoid therapy, as chronically suppressed adrenal glands may not be capable of mounting adequate response to stress. A 52-year-old Caucasian male presented with fever, orthostatic hypotension, lymphadenopathy and hyponatraemia. Serum cortisol levels were within normal levels with a sub optimal response to stimulation by ACTH. Hyponatraemia and orthostasis responded poorly to fluid restriction, saline and salt repletion but corrected after increasing the steroid dose. The normal baseline cortisol levels represented a stimulated adrenal gland, however, the ACTH stimulation had inadequate response. This sub optimal stimulation and a good response to increased steroids suggest the presence of relative or occult adrenal insufficiency. Relative adrenal insufficiency must be considered in patients who have received prolonged glucocorticoid therapy and have symptoms such as hypotension and/or hyponatraemia
Case Report - Relative Adrenal Insufficiency in Post-transplant Lymphoproliferative Disorder
Post-transplant lymphoproliferative disorder is treated with rapid
decrement of immunosuppressive therapy. This cannot be achieved with
ease in patients on long-term glucocorticoid therapy, as chronically
suppressed adrenal glands may not be capable of mounting adequate
response to stress. A 52-year-old Caucasian male presented with fever,
orthostatic hypotension, lymphadenopathy and hyponatraemia. Serum
cortisol levels were within normal levels with a sub optimal response
to stimulation by ACTH. Hyponatraemia and orthostasis responded poorly
to fluid restriction, saline and salt repletion but corrected after
increasing the steroid dose. The normal baseline cortisol levels
represented a stimulated adrenal gland, however, the ACTH stimulation
had inadequate response. This sub optimal stimulation and a good
response to increased steroids suggest the presence of relative or
occult adrenal insufficiency. Relative adrenal insufficiency must be
considered in patients who have received prolonged glucococorticoid
therapy and have symptoms such as hypotension and/or hyponatraemia. (J
Postgrad Med 2003;49:69-71
Case Report - Relative Adrenal Insufficiency in Post-transplant Lymphoproliferative Disorder
Post-transplant lymphoproliferative disorder is treated with rapid
decrement of immunosuppressive therapy. This cannot be achieved with
ease in patients on long-term glucocorticoid therapy, as chronically
suppressed adrenal glands may not be capable of mounting adequate
response to stress. A 52-year-old Caucasian male presented with fever,
orthostatic hypotension, lymphadenopathy and hyponatraemia. Serum
cortisol levels were within normal levels with a sub optimal response
to stimulation by ACTH. Hyponatraemia and orthostasis responded poorly
to fluid restriction, saline and salt repletion but corrected after
increasing the steroid dose. The normal baseline cortisol levels
represented a stimulated adrenal gland, however, the ACTH stimulation
had inadequate response. This sub optimal stimulation and a good
response to increased steroids suggest the presence of relative or
occult adrenal insufficiency. Relative adrenal insufficiency must be
considered in patients who have received prolonged glucococorticoid
therapy and have symptoms such as hypotension and/or hyponatraemia. (J
Postgrad Med 2003;49:69-71