The most frequent cause of secondary adrenal insufficiency is the prolonged exposure to exogenous glucocorticoids (GCs).(1) The source of GCs is most often obvious (oral or parenteral, or even inhaled), but it may be occasionally more difficult to identify, as GCs may be found in “traditional” or “alternative” medicines.(2) We describe here the case of a patient with secondary adrenal insufficiency due to using the same pill cutter for her medications and her dog’s prednisone.
A 45-year-old woman with history of depression presented to her internist complaining of 4 weeks of decreased appetite, nausea, weakness, and 4-kg weight loss. Symptoms had started about 1 week after her dog died…
The patient denied ever taking oral, topical, or parenteral GCs or any alternative medicine preparation. Her dog had a history of Addison’s disease and had been on prednisone for the past 6 years. She had been administering prednisone to the pet by breaking twice daily a 5-mg prednisone tablet into quarters, using a pill cutter. Over these years, she had frequently used the same pill cutter to cut her own antidepressant pills.
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–Sritika Thapa, MD and Roberto Salvatori, MD
–This article originally appeared in the November 2012 issue of The American Journal of Medicine.
