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Alan S. Krasner, MD

JAMA. 1999;282:671-676.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

CASE PRESENTATION

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.

Can you tell us how you felt when your dose was reduced to 2 mg/d?

PATIENT: I began feeling extremely weak, tired, and mildly dizzy. It wasn't anything I could pinpoint, and I didn't understand it.

DR KRASNER: Your dosage of triamcinolone was then discontinued. . . . [Full Text of this Article]

DISCUSSION

Pathogenesis of Glucocorticoid-Induced Adrenal Insufficiency

Biochemical Diagnosis of Adrenal Insufficiency

Short 250-µg ACTH Stimulation Test.

Insulin-Induced Hypoglycemia Test.

Overnight Metyrapone Test.

CRH Stimulation.

Low-dose (1 µg) ACTH Stimulation.

Predicting HPA Axis Suppression

Perioperative Evaluation and Management of Patients With HPA Axis Suppression

Withdrawing Glucocorticoid Therapy

Author Affiliation: Division of Endocrinology, The Johns Hopkins University School of Medicine, Baltimore, Md. Dr Krasner is now with Pfizer Inc, Groton, Conn.

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