{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:17:55Z","timestamp":1784557075032,"version":"3.55.0"},"reference-count":15,"publisher":"Bioscientifica","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["edm.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2022,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>Summary<\/jats:title>\n                    <jats:p>Long-term use of exogenous glucocorticoids leads to the suppression of the hypothalamic\u2013pituitary\u2013adrenal axis. Therefore, if the glucocorticoid is withdrawn abruptly, patients will develop adrenal insufficiency. Hypercalcaemia is a rare but well-known complication of adrenal insufficiency. However, hypercalcaemia is a rare presentation of glucocorticoid-induced adrenal insufficiency (GI-AI). A 62-year-old patient with a past history of diabetes mellitus, ischaemic heart disease, stroke, hypertension and dyslipidaemia presented with polyuria, loss of appetite, malaise and vomiting for a duration of 2 months. His ionized calcium level was high at 1.47 mmol\/L. Intact parathyroid hormone was suppressed (4.3 pg\/mL) and vitamin D was in the insufficient range (24.6 ng\/mL). Extensive evaluation for solid organ or haematological malignancy including contrast-enhanced CT chest, abdomen, pelvis, multiple myeloma workup and multiple tumour markers were negative. His synacthan-stimulated cortisol was undetectable thus confirming adrenal insufficiency. His adrenocorticotrophic hormone level was 3.82 pg\/mL (4.7\u201348.8) excluding primary adrenal insufficiency. His MRI brain and other pituitary hormones were normal. Further inquiry revealed that the patient had taken over-the-counter dexamethasone on a regular basis for allergic rhinitis for more than 2 years and had stopped 2 weeks prior to the onset of symptoms. Therefore, a diagnosis of GI-AI leading to hypercalcemia was made. The patient was resuscitated with intravenous fluids and replacement doses of oral hydrocortisone were started with a plan of prolonged tailing off to allow the endogenous adrenal function to recover. His calcium normalized and he made a complete recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Learning points<\/jats:title>\n                    <jats:list list-type=\"bullet\">\n                      <jats:list-item>\n                        <jats:p>Long-term use of glucocorticoids leads to the suppression of the hypothalamic\u2013pituitary\u2013adrenal axis.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>If the glucocorticoid is withdrawn abruptly, patients will develop adrenal insufficiency which is known as glucocorticoid-induced adrenal insufficiency.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>Adrenal insufficiency should be considered in the differential diagnosis of parathyroid hormone-independent hypercalcaemia.<\/jats:p>\n                      <\/jats:list-item>\n                      <jats:list-item>\n                        <jats:p>A thorough clinical history is of paramount importance in arriving at the correct diagnosis.<\/jats:p>\n                      <\/jats:list-item>\n                    <\/jats:list>\n                  <\/jats:sec>","DOI":"10.1530\/edm-21-0177","type":"journal-article","created":{"date-parts":[[2022,5,5]],"date-time":"2022-05-05T04:26:03Z","timestamp":1651724763000},"update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-2","source":"Crossref","is-referenced-by-count":6,"title":["Glucocorticoid-induced adrenal insufficiency: an uncommon cause of hypercalcaemia"],"prefix":"10.1530","volume":"2022","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3763-2020","authenticated-orcid":true,"given":"S D N","family":"De Silva","sequence":"first","affiliation":[{"name":"University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M","family":"Aravinthan","sequence":"additional","affiliation":[{"name":"University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Katulanda","sequence":"additional","affiliation":[{"name":"University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka"},{"name":"Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","reference":[{"key":"bib1","series-title":"Frontiers of Hormone Research","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1159\/000491040","article-title":"Nonparathyroid hypercalcemia","author":"Goltzman","year":"2019","unstructured":"Goltzman DNonparathyroid hypercalcemia. 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