Adrenal insufficiency secondary to glucocorticoid withdrawal in patients with brain tumor

BACKGROUND: Glucocorticoids are the main drug used to control vasogenic edema in patients with brain tumor. Rapid GC tapering may not only decompensate intracranial pressure, but also unmask SAI, and some symptoms of SAI can be mistakenly attributable to increased intracranial pressure or side effects of chemotherapy and radiation therapy. METHODS: The University of Virginia Neuro-Oncology Database was reviewed from February 2002 to January 2006, and 5 neuro-oncology patients with clinical and laboratory evidence of SAI were identified. RESULTS: In our experience, 1% of neuro-oncology patients treated with GC developed SAI. Symptoms resembled increased intracranial pressure or side effects of antineoplastic treatment. CONCLUSION: A healthy index of suspicion for this complication and use of pharmacologic testing will help avert misattribution of symptoms of SAI and its deleterious consequences.