Secondary Adrenal Insufficiency in Psoriasis

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Austin J Clin Case Rep. 2023; 10(5): 1292.

Secondary Adrenal Insufficiency in Psoriasis

Shoiab M Patto; Ejaz Alam*; Pooran Sharma; Basharat Q Dar

Senior Resident, Department of Endocrinology, GMC, Srinagar, India

*Corresponding author: Ejaz Alam Senior Resident, Department of Endocrinology, Government Medical College, Srinagar, India. Email: ejazpmch@gmail.com

Received: May 30, 2023 Accepted: June 21, 2023 Published: June 28, 2023

Abstract

A 40-year-old male with chronic plaque psoriasis developed symptoms of secondary adrenal insufficiency due to long-term use of steroids. He presented with facial puffiness, increased abdominal fat deposition, and other signs of steroid excess. Glucocorticoid replacement therapy was initiated based on body surface area, requiring careful monitoring to maintain cortisol levels and prevent excessive exposure to glucocorticoids.

Keywords: Psoriasis; Secondary adrenal insufficiency; Glucocorticoid

Case Summary

A 40-year-old male with chronic plaque psoriasis who has been using long-term systemic and topical steroid therapy presented with symptoms of facial puffiness, increased abdominal fat deposition, easy bruising, and progressively increasing reddish marks over the abdomen. On examination, he had a waist circumference of 120cm, hip circumference of 100cm, and a waist-hip ratio of 1.2. He had a moon face with facial plethora (Panel A), thin skin, and violaceous striae over the anterior abdominal wall (Panel B) with the largest diameter of 4cm (Panel C). The morning cortisol level was 0.0ug/dl, suggesting adrenal suppression due to the chronic use of exogenous steroids. This secondary adrenal insufficiency occurs when the body's natural production of cortisol is suppressed by the long-term use of steroids, leading to a decreased ability to respond to stress.

Citation: Patto SM; Alam E; Sharma P; Dar BQ. Secondary Adrenal Insufficiency in Psoriasis. Austin J Clin Case Rep. 2023; 10(5): 1292.