Japanese

Title	ステロイド外用薬の中止からステロイド離脱症候群が疑われた1例
Subtitle	症例・事例報告
Authors	多賀匠1, 畠山淳司1,2, 山本太平1,3, 室谷直樹1,4, 帯川史生1, 愛知省吾1, 尾本健一郎1,5, 栗原智宏1
Authors (kana)
Organization	1国立病院機構東京医療センター救急科, 2大阪医科薬科大学救急医学教室, 3亀田総合病院集中治療科, 4慶應義塾大学病院整形外科, 5日本医科大学多摩永山病院救急科
Journal	日本臨床救急医学会雑誌
Volume	26
Number	1
Page	55-60
Year/Month	2023 / 3
Article	報告
Publisher	日本臨床救急医学会
Abstract	【要旨】 症例は47歳, 男性. 既往歴として, 菌状息肉症があり, ショックバイタルで当院搬送となった. 腫瘍崩壊症候群, 敗血症性ショックが疑われた. 敗血症性ショックによる相対的副腎不全に対してステロイド投与を行ったところ, 速やかに循環動態は改善した. その後, ステロイド中止による循環不全が2回みられたため, 詳細な病歴聴取を家族より行ったところ, 長期間にわたるステロイド外用薬の使用が判明した. ステロイド離脱症候群が疑われたため, ステロイド投与を継続したところ, 全身状態は改善傾向にあったが, 経過中に肺炎・敗血症性ショックから多臓器不全が進行し, 死亡退院となった. 剖検の結果, 副腎の肉眼的菲薄化を認めた. 救急集中治療領域において, ショックの鑑別として, 内服薬だけでなく, ステロイド外用薬中止によるステロイド離脱症候群を疑うことも臨床上重要である.
Practice	臨床医学：外科系
Keywords	ステロイド離脱症候群, 副腎萎縮, 相対的副腎不全

English

Title	A case of suspected steroid withdrawal syndrome from discontinuation of topical steroid medication
Subtitle
Authors	Sho TAGA1, Junji HATAKEYAMA1,2, Taihei YAMAMOTO1,3, Naoki MUROYA1,4, Fumio OBIKAWA1, Shogo AICHI1, Kenichiro OMOTO1,5, Tomohiro KURIHARA1
Authors (kana)
Organization	1Department of Emergency and Critical Care Medicine, National Organization Tokyo Medical Center, 2Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 3Intensive Care Unit, Kameda Medical Center, 4Department of Orthopaedic Surgery, Keio University Hospital, 5Department of Emergency Medicine, Nippon Medical School Tamanagayama Hospital
Journal	Journal of Japanese Society for Emergency Medicine
Volume	26
Number	1
Page	55-60
Year/Month	2023 / 3
Article	Report
Publisher	Japanese Society for Emergency Medicine
Abstract	[ABSTRACT] A 47-year-old man with a history of mycosis fungoides was transported to our hospital in a state of shock, indicated by evaluation of his vital signs on admission. We suspected tumor collapse syndrome and septic shock and administered steroids for management of septic shock-induced relative adrenal insufficiency. The patient's circulatory status rapidly improved; however, he subsequently developed two episodes of circulatory failure following steroid discontinuation. Detailed medical history obtained from the family revealed long-term topical steroid use. We suspected steroid withdrawal syndrome and re-initiated steroid therapy. The patient's general condition improved, although he developed progressive pneumonia and septic shock and multiorgan failure during the course of treatment and died of these complications. Autopsy revealed significant thinning of the adrenal glands. Interpretation of the results of random serum cortisol levels may be inaccurate in emergency and intensive care settings. Clinicians should include steroid withdrawal syndrome secondary to discontinuation of topical steroids as well as oral medications in the differential diagnosis of shock.
Practice	Clinical surgery
Keywords	steroid withdrawal syndrome, adrenal atrophy, relative adrenal insufficiency

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