A patient has been on daily, high-dose glucocorticoid therapy for the treatment of rheumatoid arthritis. His prescription runs out before his next appointment with his physician
Because he is asymptomatic, he thinks it is all right to withhold the medication for 3 days. What is likely to happen to this patient? a. He will go into adrenal crisis.
b. He will go into thyroid storm.
c. His autoimmune disease will go into remission.
d. Nothing; it is appropriate to stop the medication for 3 days.
A
Patients on long-term corticosteroid therapy are at high risk for adrenal crisis, because therapy suppresses the endogenous production of steroids. Adrenal crisis may be precipitated by sudden withdrawal of glucocorticoid therapy. Thyroid storm may occur when antithyroid medications are suddenly withdrawn. Rheumatoid arthritis is likely to exacerbate with the withdrawal of glucocorticoids. Adrenal crisis may occur shortly after withdrawal of glucocorticoids.
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