SFEBES2025 ePoster Presentations Bone and Calcium (2 abstracts)
The impact of long-term intranasal steroid therapy on adrenal function: a clinical case report
Yu Qing Chang 1 , Sonia Akhter 1 , Georgina Houghton 1 , Anurup Kumar 1 , Ismail Gossiel 1 , Shahzad Akbar 2 & Narayana Pothina 1
1Scunthorpe General Hospital, Scunthorpe, United Kingdom; 2Hull Royal Infirmary, Hull, United Kingdom
We present the case of a gentleman who was investigated in the Endocrine clinic for chronic fatigue and adrenal insufficiency secondary to prolonged use of nasal steroid sprays. Nasal steroids were initially prescribed due to asthma and were discontinued in 2013. This is a 53-year-old patient with intermittent complaints of fatigue, which were alleviated by taking hydrocortisone. The initial dose of hydrocortisone was 20 mg, later reduced to 5 mg. Multiple Short Synacthen Tests (SST) consistently reflected suboptimal cortisol responses, strongly indicating a diagnosis of adrenal insufficiency. There were no gastrointestinal or cardiovascular issues, and no significant changes in weight or appetite. Following multiple endocrinology appointments and a seemingly successful trial of hydrocortisone replacement, the patient frequently altered his doses—either reducing or omitting them altogether—with no additional medical repercussions. At 5 mg of hydrocortisone, the patient experienced reduced exercise tolerance, while at doses of 15 mg or higher, he complained of worsening symptoms including headaches, hypertension, and further lethargy. Iatrogenic Cushing’s was considered and ruled out by normal renin-aldosterone levels, plasma metabolites, and the absence of any Cushingoid features. The concomitant nature of this gentleman’s chronic fatigue and adrenal insufficiency has proven to be a challenge when determining the best approach to managing his hypoadrenalism secondary to exogenous steroid use
Volume 109
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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