Ominous triad triggered by high-dose glucocorticosteroid therapy

BMJ Case Rep. 2017 Jun 18:2017:bcr2017220328. doi: 10.1136/bcr-2017-220328.

Abstract

Glucocorticosteroids (CS) play a key role in the treatment of numerous diseases. Nonetheless, they can be accompanied by several adverse effects. We present the case of a 51-year-old woman who was treated with high-dose CS for a relapse of her multiple sclerosis. After 5 days of treatment, the patient developed severe diabetic ketoacidosis, hypertriglyceridemia and acute pancreatitis-a potentially life-threatening triad which has previously been described, in our case, however, for the first time as a complication of CS therapy. Our patient's condition was further aggravated by a circulatory shock, haemodynamic relevant bleeding from a duodenal ulcer and psychotic symptoms. In the intensive care unit, intravenous insulin infusion, fluid resuscitation, catecholamine support, electrolyte supplementation, endoscopic haemoclipping and antibiotic and antipsychotic treatment were administered, leading to a continuous improvement of the patient's health state.

Keywords: Contraindications and precautions; Diabetes; Lipid disorders; Metabolic disorders; Pancreatitis.

Publication types

  • Case Reports

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / adverse effects*
  • Critical Care
  • Diabetic Ketoacidosis / chemically induced*
  • Female
  • Fluid Therapy
  • Humans
  • Hypertriglyceridemia / chemically induced*
  • Infusions, Intravenous
  • Insulin / therapeutic use*
  • Middle Aged
  • Multiple Sclerosis / complications
  • Multiple Sclerosis / drug therapy*
  • Multiple Sclerosis / physiopathology
  • Pancreatitis / chemically induced*
  • Psychotic Disorders
  • Recurrence
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Insulin