Secondary adrenal insufficiency after intrathecal steroid administration

Case report

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✓ A 38-year-old man developed secondary adrenal insufficiency as a consequence of intrathecal methylprednisolone administration. Evidence in support of this diagnosis included an absent plasma cortisol response to insulin-induced hypoglycemia, an inadequate adrenal response to exogenous corticotropin stimulation, a typical delayed response to prolonged corticotropin infusion over 3 days, and the finding of an elevated level of prednisolone in the cerebrospinal fluid a full 2 months after its administration. It is therefore recommended that patients receiving intrathecal steroids be carefully observed for the possible development of secondary adrenal insufficiency.

Article Information

Address reprint requests to: Bart Chernow, M.D., Box 129, National Naval Medical Center, Bethesda, Maryland 20814.

© AANS, except where prohibited by US copyright law.

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Figures

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    Plasma cortisol concentration over time (minutes) following intravenous administration of 250 µg of alpha 1,24 corticotropin at time zero.

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    Urinary 17-hydroxycorticosteroid excretion in mg/24 hrs during daily 8-hour infusions of 250 µg of alpha 1,24 corticotropin for 3 days beginning on Day 1. Baseline 24-hour excretion (not shown in figure) was less than 0.2 mg/24 hrs.

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    Response of serum glucose (upper), plasma cortisol (center), and plasma growth hormone (GH) (lower) to insulin (0.1 units/kg) given intravenously at time zero.

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