REPORT OF A CASE
Inpatient consultation was requested for a 13-year-old boy with a recurrent brain-stem glioma.He presented 9 months earlier complaining of balance problems, diplopia, and change in vision. At that time, a computed tomogram and magnetic resonance image demonstrated a mass in the brain stem. He underwent a proximal resection and was subsequently treated with radiotherapy and chemotherapy consisting of etoposide, mesna, ifosfamide, and carboplatin. No improvement was noted, and the tumor continued to enlarge despite multiple courses of chemotherapy.On first diagnosis, he had been prescribed dexamethasone to minimize edema of the tumor mass and compression of the brain stem. Over the subsequent 9 months, his dose of dexamethasone varied (1 g every morning to 4 g every 6 hours) depending on changes in his neurologic examination. As a result of long-term corticosteroid use, diabetes, fatty changes of the liver manifested by elevated liver