Author Affiliation: Division of Endocrinology, The Johns Hopkins University School of Medicine, Baltimore, Md. Dr Krasner is now with Pfizer Inc, Groton, Conn.
Grand Rounds at The Johns Hopkins Hospital Section
Editors: David B. Hellmann, MD, D. William Schlott, MD, Stephan D.
Sisson, MD, The Johns Hopkins Hospital, Baltimore, Md; David S. Cooper, MD,
Contributing Editor, JAMA.
DR KRASNER: Our patient is a 36-year-old woman.
Around 15 years ago, she began suffering recurrent episodes of acute sinusitis,
followed by asthma attacks. She was treated repeatedly with bronchodilators,
antibiotics, and short courses of glucocorticoids. During this time, she underwent
5 operations for hyperplastic sinus polyps. Two years ago, after a particularly
severe asthma attack, her physician prescribed an indefinite course of glucocorticoid
therapy. She began with prednisone, 25 mg/d for 2 months, followed by 20 mg/d
for 2 more months. Then her medication was changed to triamcinolone, starting
at 4 mg/d and the dosage slowly tapered to 2 mg/d.
Krasner AS. Glucocorticoid-Induced Adrenal Insufficiency. JAMA. 1999;282(7):671-676. doi:10.1001/jama.282.7.671