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Aprilia, Dinda
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Journal : Universa Medicina

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Glucocorticoid-induced adrenal insufficiency after receiving intravenous methylprednisolone for Graves' ophthalmopathy: a case report Pradwi Efendi, Yanne; Aprilia, Dinda; Decroli, Eva
Universa Medicina Vol. 45 No. 1 (2026): Aheaf Of Print
Publisher : Faculty of Medicine, Universitas Trisakti

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18051/UnivMed.2026.v45.%p

Abstract

BACKGROUNDGraves’ ophthalmopathy (GO) is the most common extrathyroidal manifestation of Graves’ disease and can significantly impair visual function and quality of life. High-dose intravenous methylprednisolone (IVMP) is recommended as first-line therapy for moderate-to-severe active GO due to its superior efficacy and tolerability compared with oral glucocorticoids. However, IVMP therapy may be associated with rare but potentially serious adverse effects, including suppression of the hypothalamic–pituitary–adrenal (HPA) axis leading to GI adrenal insufficiency (GI-AI). Case descriptionWe report the case of a 38-year-old man with Graves’ disease who developed AI following IVMP therapy for moderate-to-severe GO. The patient received five weekly doses of IVMP 500 mg (cumulative dose 2.5 g) for progressive ocular symptoms. He subsequently presented with fatigue, weight gain, moon face, and buffalo hump. Laboratory evaluation revealed a markedly low morning serum cortisol level of 1 mcg/dL, confirming adrenal insufficiency. Patient was diagnosed with GI-AI accompanied by features of iatrogenic Cushing’s syndrome. Management consisted of hydrocortisone replacement therapy at a dose of 20 mg/day along with ongoing antithyroid treatment using methimazole. Serial monitoring of cortisol levels demonstrated gradual recovery of HPA axis function, accompanied by clinical improvement. ConclusionThis case highlights that glucocorticoid-induced adrenal insufficiency can occur on IVMP used for GO. Clinicians should maintain a high index of suspicion and perform appropriate adrenal function monitoring during and after IVMP therapy to ensure early detection and safe management of this potentially life-threatening complication.
Co-Authors A, Amelianda Agustina, Ade Ajisoko, Pangkuh ALADIN ALADIN Alamsyah, Lucky Alfitri, Maura Salsabila Aliyah, Fhadilah Abir Amali Putra ANGGIA PUTRI Aryati, Fitri Ashari, Amelia Tri Balafif, Mohammad Dwitya Elvira, Dwitya Efandra, Rizky Efendi, Yanne Pradwi Elmatris Sy Eva Decroli Fadella, Annesa Fereshti Lailani Fuada, Afifah Annis Handito, Angga Putra Herinda, Dwi Putri Idhia Sriliana Indah Noviandari, Indah Julianawati, Tinta Kam, Alexander LUKMAN NURHAKIM, LUKMAN Masrul Melliana, Melliana Meriry, Laying Ayu Mery, Andi Miza, Mohammad Agha Dhiyahul Muhammad Faishal Mulyana, Adin Namanda Putri, Athari Fadhila Nelmi Silvia Nugraha, Tirta Nursapia Harahap Pradwi Efendi, Yanne Pransiska, Dini Pulungan, Nailah Putri, Biomechy Oktomalio Putri, Septia Harma Rahayuningsih, Sri Puji Rahmatiar, Yuniar Ramadhan, Topani Reny Puspasari, Reny Rikarni Rikarni Rudy Afriant Sinaga, Asmawarna Sofiani, Dinda Putri Suhaillah, Yusrah Tamayo, Auliangi Ulvyana, Vyora Umayra, Aisyah Vebiliza, Ketrin Winata, Aji Pandu Yana, Lusi Yulia, Dwi Zelly Dia Rofinda