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February 24, 1997

Addison Disease in Patients Treated With Glucocorticoid Therapy

Author Affiliations

From the Departments of Medicine (Drs Cronin, Murnaghan, and Shanahan), Neurology (Dr Callaghan), and Paediatrics (Dr Kearney), Cork University Hospital, Cork, Ireland.

Arch Intern Med. 1997;157(4):456-458. doi:10.1001/archinte.1997.00440250114013

Acute adrenal crisis in patients with unrecognized chronic adrenocortical failure is difficult to diagnose and potentially fatal. We describe 2 patients with acute adrenal crisis whose diagnoses were hindered because of concomitant glucocorticoid treatment. Acute adrenal insufficiency is primarily a state of mineralocorticoid deficiency. Prednisolone and prednisone, the most frequently prescribed anti-inflammatory corticosteroid agents, have minimal mineralocorticoid activity. Several conditions that may be treated with pharmacological glucocorticoids are associated with an increased risk of Addison disease. An acute adrenal crisis, against which concurrent glucocorticoid therapy does not confer adequate protection, may develop in such patients.

Arch Intern Med. 1997;157:456-458