SHM Converge Scientific Abstract ePoster Gallery-Opioid-Induced Central Adrenal Insufficiency Presenting as Fever of Unknown Origin

Pdf Summary

This case report describes a 31-year-old man with hidradenitis suppurativa, prior opioid use disorder, and current methamphetamine use who was hospitalized for worsening painful draining wounds and persistent fevers. He initially received antibiotics for suspected skin infection, but despite extensive evaluation, repeated blood cultures remained negative and fevers continued. He later developed shock requiring ICU transfer and vasopressor support, prompting broader infectious workup and multiple antibiotic changes, including stopping antibiotics to assess for drug fever.<br /><br />Because fevers and hypotension persisted without an infectious source, adrenal insufficiency was investigated. Laboratory testing showed a low morning cortisol, low free T4 and total T3, and an abnormal cosyntropin stimulation test, supporting central adrenal insufficiency (CAI). Brain MRI revealed an incidental pituitary microadenoma, though the authors emphasize opioid use as the likely contributor. He had been receiving high-dose oxycodone for pain control, and chronic opioid exposure is known to suppress the hypothalamic-pituitary-adrenal axis. He improved after starting hydrocortisone and was transitioned to suboxone before discharge.<br /><br />The report highlights that CAI is rare and often missed because its symptoms are nonspecific, including fatigue, hyponatremia, electrolyte abnormalities, and fever of unknown origin. Persistent fever may result from impaired immune and cytokine regulation due to inadequate cortisol response. The authors stress that chronic opioid use, including high-dose opioids and possibly suboxone, should be considered a risk factor for CAI. In patients with unexplained fevers, hypotension, or shock—especially those on opioids—clinicians should maintain a high index of suspicion for adrenal insufficiency.

Asset Subtitle

Lauren Monaco

Meta Tag

Author List Giuliana G. Berardi, Lauren Monaco, Morgan Venuti, Nicole Keane, Summer Nestorowicz

Category Clinical Vignettes

Concept Central Adrenal Insufficiency

Concept Fever of Unknown Origin

Concept Opioid Use

Concept ACTH Stimulation Test

Concept Glucocorticoid Replacement

Distinguished Non-Finalist

Presenter Organization Temple University Hospital

Presenting Author Lauren Monaco

Track Adult

Keywords

central adrenal insufficiency

opioid use disorder

hidradenitis suppurativa

persistent fever

shock

hydrocortisone

cosyntropin stimulation test

pituitary microadenoma

methamphetamine use

adrenal insufficiency

Central Adrenal Insufficiency

Fever of Unknown Origin

Opioid Use

ACTH Stimulation Test

Glucocorticoid Replacement