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Journal of Postgraduate Medicine
Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India
ISSN: 0022-3859 EISSN: 0022-3859
Vol. 57, No. 3, 2011, pp. 218-220
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Bioline Code: jp11058
Full paper language: English
Document type: Case Report
Document available free of charge
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Journal of Postgraduate Medicine, Vol. 57, No. 3, 2011, pp. 218-220
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Severe intestinal pseudo-obstruction following withdrawal from over-the-counter steroid abuse
Sharma, A; Naraynsingh, V; Goalan, R & Teelucksingh, S T.
Abstract
Relative adrenal insufficiency (RAI) is commonly diagnosed in critically ill patients failing to maintain a pressor response and/or with electrolyte abnormalities. We report a case of a 59-year-old man who presented with diverticular bleeding and developed prolonged ileus postoperatively. After observing arthritic joints on examination, further questioning revealed long-term, high-dose steroid use for analgesic effect. Failure to produce an effective cortisol response was due to adrenal suppression from continuous steroid use. Immediate improvement of his ileus was seen after steroid replacement. Unreported self-medication is a frequent problem encountered in developing countries. RAI can be easily missed and requires a high index of suspicion in any patient who fails to respond to conventional treatment or with long-term steroid use.
Keywords
Adrenal insufficiency, ileus, pseudo-obstruction, self-medication
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