A bulking agent may lead to adrenal insufficiency crisis: a case report

Adrenal insufficiency is a life-threatening disorder which must be treated with glucocorticoid replacement and needs permanent dose adjustment during patient's different somatic situations. Insufficient glucocorticoid doses result in adrenal crisis and must be treated with intravenous hydrocort...

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Bibliographic Details
Published in:Acta medica Iranica 2011, Vol.49 (10), p.688-689
Main Authors: Ahi, Salma, Esmaeilzadeh, Majid, Kayvanpour, Elham, Sedaghat-Hamedani, Farbod, Samadanifard, Seyed Hossein
Format: Article
Language:English
Subjects:
Adrenal Insufficiency
Adrenal Insufficiency - chemically induced
Adrenal Insufficiency - drug therapy
Anti-Inflammatory Agents - metabolism
Anti-Inflammatory Agents - therapeutic use
Cathartics - adverse effects
Drug Interactions
Female
Fludrocortisone - metabolism
Fludrocortisone - therapeutic use
Hormone Replacement Therapy
Humans
Hydrocortisone
Intestinal Absorption - drug effects
Middle Aged
Prednisolone - metabolism
Prednisolone - therapeutic use
Psyllium
Psyllium - adverse effects
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Summary:Adrenal insufficiency is a life-threatening disorder which must be treated with glucocorticoid replacement and needs permanent dose adjustment during patient's different somatic situations. Insufficient glucocorticoid doses result in adrenal crisis and must be treated with intravenous hydrocortisone. The patient was known with Adrenal insufficiency and was treated optimally with fludrocortisone and prednisolone since seven years with no history of adrenal crisis. The patient was admitted with abdominal pain, weakness, fatigue and nausea developed 3-4 days after taking psyllium, a bulking agent, prescribed by a surgeon to diagnose anal fissure. Detailed medical history, physical examinations, laboratory and imaging examinations did not approve any other cause of adrenal crisis. Psyllium may interfere with gastrointestinal absorption of prednisolone and/or fludrocortisone and trigger acute adrenal crisis in patients with adrenal insufficiency.
ISSN:0044-6025
1735-9694
0173-5969