Abstract
We report a 19-year-old female case of short bowel syndrome (SBS) complicated with membranoproliferative glomerulonephritis. She underwent extensive resection of the small intestine and jejunoileostomy due to malrotation of the intestine in the neonatal period. Home parenteral nutrition has been conducted since infancy because of SBS with a 6 cm length of small intestine. At 19 years old, she was diagnosed with membranoproliferative glomerulonephritis by renal biopsy. Considering impaired absorption of steroids in this SBS patient, alternate-day prednisolone (PSL) therapy was first performed by intravenous administration for a fixed period, and then changed to the administration of oral medication. Urinary free cortisol was measured to evaluate PSL absorption status. High cortisol levels due to cross-reaction with PSL were observed on days of administration, and low cortisol levels due to suppressed adrenocortical function were observed on non-administration days. The fluctuation levels observed during the oral administration period were quite similar with the levels during the intravenous administration period. These findings indicate that oral PSL administration is available in this SBS patient with a less than 35 cm length of small intestine. Measurement of urinary free cortisol, a marker of endogenous steroid hormone secretion, also appears useful in the evaluation of adrenal function during steroid therapy.
