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Adrenal Crisis as An Adverse Reaction to Zoledronic Acid in a Patient With Primary Adrenal Insufficiency: A Case Report and Literature Review

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Koransky, Alison
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Genre
Journal article
Date
2023-03-24
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Group
Temple University. Hospital
Department
Internal Medicine
Endocrinology, Diabetes, and Metabolism
Subject
Adrenal crisis
 Adrenal insufficiency
 Bisphosphonate
 Zoledronic acid
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http://hdl.handle.net/20.500.12613/9036
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Open Access Publishing Fund
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KuoEtAl-JournalArticle-2023-03.pdf
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DOI
https://doi.org/10.1016%2Fj.aace.2022.12.003
Abstract
Background/Objective: Adrenal crisis is a medical emergency and an acute complication of adrenal insufficiency (AI). It can be triggered by stressors such as infection, dehydration, trauma, or surgery. Case Report: We present a case of a 70-year-old woman with a history of Addison’s disease, who presented in adrenal crisis within 24 hours after receiving her first infusion of zoledronic acid. No trigger was identified after extensive evaluation, making infusion with zoledronic acid the most likely cause of adrenal crisis. Discussion: Adverse reactions to medications can potentially trigger adrenal crisis. The present case report demonstrates that intravenous bisphosphonates can cause an acute phase reaction that may lead to adrenal crisis. Given the increased risk of osteoporosis in patients with AI there is an increased likelihood of prescription of intravenous bisphosphonates in this patient population. Conclusion: Patients with AI undergoing infusion with zoledronic acid may require an increased dose of glucocorticoid prior to infusion and may need to undergo monitoring post infusion for possible adrenal crisis.
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Citation
Bryan Kuo, Alison Koransky, Cherie Lisa Vaz Wicks, Adrenal Crisis as An Adverse Reaction to Zoledronic Acid in a Patient With Primary Adrenal Insufficiency: A Case Report and Literature Review, AACE Clinical Case Reports, Volume 9, Issue 2, 2023, Pages 32-34, ISSN 2376-0605, https://doi.org/10.1016/j.aace.2022.12.003. (https://www.sciencedirect.com/science/article/pii/S2376060522000876)
Citation to related work
Elsevier
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AACE Clinical Case Reports, Vol. 9, Iss. 2
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