Secondary Adrenal Insufficiency due to Intra-articular Glucocorticoid Injections.

BACKGROUND: The most common cause of hypothalamic-pituitary-adrenal axis suppression is systemic glucocorticoids administration. CASE CHARACTERISTICS: A 14-year-old boy with juvenile idiopathic arthritis receiving repeated intra-articular steroids for last 3 years developed fever, fatigue, nausea and abdominal pain. Stimulation with low-dose Synathen revealed low adrenal reserve, suggesting secondary adrenal insufficiency. OUTCOME: Temporary hydrocortisone substitution therapy improved condition. MESSAGE: Intra-articular steroids may cause potentially life-threatening suppression of the hypothalamic-pituitary-adrenal axis.