A case of drug-induced adrenocortical insufficiency that was diagnosed as hypotension in a hemodialysis patient

Abstract

This case involved an 89-year-old male with chronic renal failure due to nephrosclerosis, who had been on hemodialysis for 19 years. He was diagnosed with prostate cancer at the age of 75 and was treated with a gonadotropin-releasing hormone agonist. As his prostate cancer became medical castration-resistant, 5mg/day prednisolone was administered concomitantly with the CYP17 inhibitor abiraterone acetate (AA). Six months later, he became hypotensive independent of dialysis, and his symptoms persisted despite his target weight increasing. Blood endocrine tests showed a low level of cortisol, a high level of ACTH, and a normal upper limit level of aldosterone. His hypotension improved rapidly after the short-term administration of hydrocortisone. Based on an interview with the patient, it was suspected that the adrenocortical insufficiency had been caused by the patient forgetting to take prednisolone under AA treatment. Therefore, the AA was discontinued first, and then the prednisolone was gradually tapered and discontinued. After the patient’s medication was stopped, his serum cortisol level was maintained with the standard range, and hemodialysis proceeded smoothly without hypotensive symptoms.