Tertiary Adrenal Insufficiency in An Asthmatic Patient on Steroid Treatment

SUMMARY Steroid treatment in asthma patients leads to many side effects. Cushing Syndrome is more common than adrenal insufficiency as a side effect of systemic steroid treatment. We presented the case of tertiary adrenal insufficiency secondary to steroid treatment. A 61 years old female asthmatic patient who had systemic and inhaler steroid treatment for approximately 30 years was admitted to the hospital with the symptoms of dyspnea, nausea and vomiting. The patient was very thin (43 kg) and had dark pigmented face and legs. Both plasma cortisole level (0.39 µg/dL) and ACTH level (< 5 pg/mL) were very low. A short synacthen stimulation test revealed a rising in basal cortisole levels. Therapeutic glucocorticoid administration is the most common cause of adrenal insufficiency. Symptoms like nausea and vomiting can be misdiagnosed because of the adverse effects of drugs usually used in the treatment of asthma and adrenal insufficiency may not be diagnosed if it is not suspected.