Adrenal Crisis as An Adverse Reaction to Zoledronic Acid in a Patient With Primary Adrenal Insufficiency: A Case Report and Literature Review

Background/objective: Adrenal crisis is a medical emergency and an acute complication of adrenal insufficiency (AI). It can be triggered by stressors such as infection, dehydration, trauma, or surgery.

Case report: We present a case of a 70-year-old woman with a history of Addison's disease, who presented in adrenal crisis within 24 hours after receiving her first infusion of zoledronic acid. No trigger was identified after extensive evaluation, making infusion with zoledronic acid the most likely cause of adrenal crisis.

Discussion: Adverse reactions to medications can potentially trigger adrenal crisis. The present case report demonstrates that intravenous bisphosphonates can cause an acute phase reaction that may lead to adrenal crisis. Given the increased risk of osteoporosis in patients with AI there is an increased likelihood of prescription of intravenous bisphosphonates in this patient population.

Conclusion: Patients with AI undergoing infusion with zoledronic acid may require an increased dose of glucocorticoid prior to infusion and may need to undergo monitoring post infusion for possible adrenal crisis.