Recovery of adrenal function in a patient with iatrogenic adrenal insufficiency temporally associated with methamphetamine use: a case report

Abstract Background Iatrogenic adrenal insufficiency is a recognized complication of prolonged, high-dose exogenous glucocorticoid therapy and may result in persistent dependence on replacement therapy. We report a case of apparent recovery of adrenal function temporally associated with methamphetamine self-administration in a patient with prolonged glucocorticoid-induced adrenal suppression. Case presentation We describe the case of a Caucasian man who developed persistent adrenal insufficiency following a skiing accident with cervical C3/4 fracture, for which he received hydrocortisone during a 13-month hospitalization episode. After glucocorticoid withdrawal, he developed symptoms consistent with adrenal insufficiency, which were supported by short Synacthen testing. Hydrocortisone replacement therapy was initiated at 10/5/5 mg daily regimen, but symptom control remained poor despite dose escalation and repeated rescue intramuscular hydrocortisone injections for recurrent adrenal crises. After three years of replacement therapy, the patient independently initiated using crystal methamphetamine in an attempt to relieve symptoms. He subsequently reported symptomatic improvement, reduced frequency of adrenal crises, and gradual weaning of hydrocortisone requirement. This was temporally associated with progressive recovery of endogenous adrenal function on serial short Synacthen testing. One year later, hydrocortisone had been discontinued, serum cortisol levels had improved into the normal range, and symptoms had resolved. At latest follow-up, he remained off regular hydrocortisone and had also discontinued methamphetamine use. Conclusions This case demonstrates a possible temporal association between methamphetamine self-use and apparent clinical and biochemical recovery from iatrogenic adrenal insufficiency. However, causality cannot be inferred, and alternative explanations, including delayed spontaneous recovery cannot be ruled out.