Harrison's PodClass: Internal Medicine Cases and Board Prep Ep 176: A 34-Year-Old Who Skipped Medications
Dec 11, 2025
Delve into the challenges faced by a 34-year-old woman on a cruise who forgets her medications. Discover the potential complications of glucocorticoid-induced adrenal insufficiency and the critical role of hydrocortisone in her treatment. Learn about the various causes of adrenal insufficiency and how steroid use can suppress the HPA axis. The hosts explore the implications of inhaled steroids and potential drug interactions. Get insights on managing withdrawal symptoms and the importance of patient education on tapering. It's a fascinating look at medication adherence and its real-world impact!
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Cruise-Related Medication Omission
- A 34-year-old woman on a Caribbean cruise forgot her meds and developed days of malaise, nausea, muscle and joint pain, and sleep disturbances.
- She had severe asthma and allergic bronchopulmonary aspergillosis and had been on high-dose inhaled fluticasone and itraconazole.
Treat Acute Steroid Withdrawal With Hydrocortisone
- Do give oral hydrocortisone for symptomatic glucocorticoid withdrawal when chronic steroid users lack access to their meds.
- Treat promptly because hydrocortisone relieves symptoms quickly and prevents progression to hemodynamic collapse.
HPA Suppression Is A Common Cause
- Exogenous glucocorticoids suppress the HPA axis and commonly cause adrenal insufficiency after prolonged exposure.
- Up to 2% of people in developed countries may have HPA-axis suppression from exogenous steroids.
