At Tam Anh General Hospital, TP HCM, Dr. Tran Thuy Ngan, from the Department of Endocrinology and Diabetes, diagnosed Nhien with acute adrenal crisis. The patient presented with dehydration, high fever, hyponatremia (below 135 mEq/L), and a critically low blood cortisol level of 12 nmol/L (normal range 120-500 nmol/L). Nhien received immediate treatment, including intravenous fluids, injections to restore water and electrolyte balance, hormone replacement, and continuous monitoring.

The patient stated she frequently used a nasal spray for allergic rhinitis. Dr. Ngan suggested that this nasal spray likely contained corticosteroids, which affected the adrenal glands.

Normally, the pituitary gland secretes ACTH hormone, stimulating the adrenal glands to increase cortisol production. When blood cortisol levels are high, the pituitary gland receives a signal to reduce ACTH secretion, thereby decreasing adrenal gland activity. Conversely, when blood cortisol levels drop, or when the body requires more cortisol (such as during illness, fever, or stress), the pituitary gland secretes more ACTH to stimulate the adrenal glands to work harder, increasing cortisol production to meet the body's needs.

Nhien is being treated for adrenal insufficiency at the Department of Endocrinology and Diabetes. *Photo: Tam Anh General Hospital*.

Excessive use of corticosteroid-containing medications increases the level of exogenous corticosteroids, inhibiting the pituitary gland from secreting ACTH and rendering the adrenal glands inactive. If this condition persists, the adrenal glands can atrophy, become unable to secrete cortisol, and permanently lose function, according to Dr. Ngan.

Nhien stopped her corticosteroid medication and began treatment with intravenous and oral hormone replacement. However, the patient did not tolerate the oral medication and required intramuscular injections.

After one week of treatment, the patient's health stabilized. She was discharged and will have regular follow-up appointments for dose adjustment and screening for complications related to long-term corticosteroid use.

Treatment for drug-induced adrenal insufficiency varies depending on the patient's condition. Most patients require hormone replacement therapy to compensate for hormone deficiency. The duration of hormone replacement therapy depends on the recovery capacity. Patients with mild conditions may recover after 6-12 months, while severe cases require two to three years; however, some individuals with permanent adrenal insufficiency must use hormone replacement for life.

The doctor noted that corticosteroids in oral, injectable, topical, or nasal spray forms can enter the bloodstream over time. Misuse of corticosteroid medications leads to early adrenal insufficiency. Patients should not self-medicate or use any corticosteroid-containing drugs without a doctor's prescription.

Bach Duong

*Patient's name has been changed.