Corticosteroid-Induced Adrenal Insufficiency in Africa: Report of Nine Cases at the Internal Medicine/Endocrinology-Diabetology Department of Pikine NHC

• 作者: Abdou Dieng Abdoulaye Leye Mamadou Ba Nafy Ndiaye Ngone Diaba Diack Yakham Mohamed Leye
• 来源期刊: 内分泌与新陈代谢疾病期刊(英文)
• 学科: 医学
• 关键词: Adrenal Insufficiency CORTICOTHERAPY Artificial Depigmentation SELF-MEDICATION
• 年，卷（期）: 2020,（12）
• 页码范围: 155-163
• 页数: 9页
• 分类号: R73

摘要

<div style="text-align:justify;"> <strong>Introduction:</strong> <span "="">Prolonged corticosteroid therapy is labeled as the main cause of corticotropic adrenal insufficiency. However, the current frequency of this complication remains unknown. The objective of our study was to assess its epidemiologic, diagnostic, therapeutic, and evolutionary aspects of our practice.<b> Methodology: </b>A 60-month retrospective study was performed from May 2014 to April 2020 in the Pikine National Hospital Centre. Data were obtained from the medical records of patients with corticosteroid-induced adrenal insufficiency. Epidemiologic, diagnostic, therapeutic, and evolutionary parameters, and data related to corticotherapy were recorded.<b> </b>Patients with basal plasma cortisol levels <50 ng/ml or a plasma cortisol level less than double of the basal cortisolaemia one H after administration of synachtene 250 were included. <b>Results: </b>Medical records were obtained from nine patients, comprising six women and three men. The mean age of the patients was 48 years. Long-term corticosteroid therapy was used for self-medication in six patients and artificial bleaching in the remaining three patients. Betamethasone was the most commonly used drug in four patients, followed by clobetasol in three patients. Corticotropic insufficiency was revealed as a result of acute decompensation in five patients. All patients presented with a pseudo-cushingoid pattern. Diagnosis of corticotropic adrenal insufficiency was confirmed by measuring basal plasma cortisol levels of <50 ng/ml in seven patients. A standard Synachtene test was performed on two patients. All patients benefited from hydrocortisone supplementation. In the short-term, the outcome was unremarkable for all patients. Medium and long-term progression could be assessed in only three patients. Two patients showed persistent suppression with a 6- and 9-month follow-up. One patient was readmitted after one month due to an adrenal crisis following voluntary discontinuation of hydroc