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Year : 2011  |  Volume : 57  |  Issue : 3  |  Page : 218-220

Severe intestinal pseudo-obstruction following withdrawal from over-the-counter steroid abuse

Departments of Clinical Medical and Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies

Correspondence Address:
A Sharma
Departments of Clinical Medical and Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago
West Indies
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0022-3859.85212

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Relative adrenal insufficiency (RAI) is commonly diagnosed in critically ill patients failing to maintain a pressor response and/or with electrolyte abnormalities. We report a case of a 59-year-old man who presented with diverticular bleeding and developed prolonged ileus postoperatively. After observing arthritic joints on examination, further questioning revealed long-term, high-dose steroid use for analgesic effect. Failure to produce an effective cortisol response was due to adrenal suppression from continuous steroid use. Immediate improvement of his ileus was seen after steroid replacement. Unreported self-medication is a frequent problem encountered in developing countries. RAI can be easily missed and requires a high index of suspicion in any patient who fails to respond to conventional treatment or with long-term steroid use.


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Online since 12th February '04
2004 - Journal of Postgraduate Medicine
Official Publication of the Staff Society of the Seth GS Medical College and KEM Hospital, Mumbai, India
Published by Wolters Kluwer - Medknow