SHM Converge Scientific Abstract ePoster Gallery-An Unsual Case of Rhabdomyolysis Due to Tertiary Adrenal Insufficiency

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This case report describes a 59-year-old woman with uncontrolled asthma and repeated systemic corticosteroid use who had recurrent, non-traumatic rhabdomyolysis. She presented with muscle aches and tenderness in all extremities, and her creatine kinase (CK) was elevated to 1127 U/L. Basic laboratory testing, including metabolic panel, CBC, urinalysis, and toxicology screen, was unremarkable.<br /><br />Because common causes were not found, further workup was done. Autoimmune, inflammatory, infectious, thyroid, aldosterone, and renin studies were negative or non-contributory. Morning ACTH and cortisol levels were low, and a low-dose cosyntropin stimulation test showed an inadequate cortisol response, supporting tertiary adrenal insufficiency due to chronic steroid exposure.<br /><br />She was treated with oral hydrocortisone and improved, with fewer hospital and ED visits and declining CK levels after treatment and hydration. The report emphasizes that rhabdomyolysis is usually caused by trauma, drugs, or infection, while endocrine causes are rare and can be overlooked. It also notes that only a small number of adrenal insufficiency cases presenting as rhabdomyolysis have been reported, and tertiary adrenal insufficiency is especially uncommon.<br /><br />The key message is that clinicians should consider adrenal insufficiency in patients with recurrent unexplained rhabdomyolysis, even when electrolytes and hemodynamics are normal. Early recognition and treatment may prevent repeated admissions and further complications.

Asset Subtitle

Fareeha Khan

Meta Tag

Author List Fareeha Khan

Category Clinical Vignettes

Concept Rhabdomyolysis

Concept Adrenal Insufficiency

Concept Tertiary Adrenal Insufficiency

Concept ACTH Stimulation Test

Concept Glucocorticoid Replacement

Distinguished Non-Finalist

Presenter Organization Loyola University Medical Center

Presenting Author Fareeha Khan

Track Adult

Keywords

rhabdomyolysis

adrenal insufficiency

tertiary adrenal insufficiency

chronic corticosteroid use

asthma

creatine kinase

hydrocortisone

cosyntropin stimulation test

muscle pain

endocrine causes

Rhabdomyolysis

Adrenal Insufficiency

Tertiary Adrenal Insufficiency

ACTH Stimulation Test

Glucocorticoid Replacement