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Do Steroids Withdrawal Lead To Acute Adrenal Insufficiency?
Question: Hello, my seventy year old husband used prednisolone for 20 yrs , he had chronic exzema and sarcoidosis (in lungs & later heart, fitted pacemaker) also diagnosed with heart failure. He developed an ulcer, and was bringing up blood and was rushed to hospital. Successfully treated, but he did not get better. The following 15 days, until his death, he experienced periods of anal bleeding. On admission his steroids (15mg maint dose) were stopped for at least 3 days, 8 days later, at patient prompting, 40mg stress dose given for 1 day then 30mg thereafter. He was dehydrated for 5 days from admission, he had periods of hypotension, vomiting, very hot head/hands profoundly weak, all prior to stress dose. Was this Acute Adrenal Insuffiency? Can this contribute to Mesenteric Ischaemia/Infarction.
Brief Answer:
Possibly
Detailed Answer:
I am very sorry to learn about this.
It is possible he experienced acute adrenal insufficiency due to steroid withdrawal. The abrupt stoppage of corticosteroid medications can potentially result in such a problem. This is particularly likely when a person has been on steroids for a prolonged length of time, such as several years.
As you seem to have clearly surmised, suddenly stopping prednisolone 15 mg maintenance dose that he had been on for 20 years , would likely have made him prone to developing acute adrenal insufficiency, especially when he was already in a stressful situation from the hospitalisation for ulcer/bleeding. Stress cover is typically initiated in these circumstances to prevent this complication from occuring.
Possibly
Detailed Answer:
I am very sorry to learn about this.
It is possible he experienced acute adrenal insufficiency due to steroid withdrawal. The abrupt stoppage of corticosteroid medications can potentially result in such a problem. This is particularly likely when a person has been on steroids for a prolonged length of time, such as several years.
As you seem to have clearly surmised, suddenly stopping prednisolone 15 mg maintenance dose that he had been on for 20 years , would likely have made him prone to developing acute adrenal insufficiency, especially when he was already in a stressful situation from the hospitalisation for ulcer/bleeding. Stress cover is typically initiated in these circumstances to prevent this complication from occuring.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you very much for your prompt reply, it was most helpful. Please could you advise whether you would recommend also seeking the opinion of a gastroenterologist to be able to fully understand what happened to my late husband.
Brief Answer:
Follow up
Detailed Answer:
Yes it would certainly help to consult a gastroenterologist, in order to get a detailed explanation of your late husband's ulcer/bleeding problem.
Follow up
Detailed Answer:
Yes it would certainly help to consult a gastroenterologist, in order to get a detailed explanation of your late husband's ulcer/bleeding problem.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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