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CPE-008 · synthetic case ADR-FX-10
Repeated joint injections and high-dose inhaled steroid
Non-oral routes count.
Purpose: Non-oral routes count.
Inputs the engine received
Chemistry and vitals
- Age
- 58 years
Symptoms and signs
- Fatigue
- Yes
Exposures, history and context
- High-dose inhaled, injected or topical glucocorticoid
- Yes
What the engine reports
Insufficiency is possible, particularly if the dose is reduced or stopped, or during illness. Do not stop glucocorticoids abruptly; any taper is the physician's plan. Provide sick-day guidance and consider testing.
Detected clinical pattern
Glucocorticoid Exposure — Risk of Adrenal Suppression
Exposure that can suppress the adrenal axis is documented. Do not stop abruptly.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Do not stop glucocorticoids abruptly; physician to plan any taper, and provide sick-day guidance.ESE/Endocrine Society 2024.
Evidence and rule trace · 1 rules
AI-10Glucocorticoid exposure
Inputs: high-dose inhaled, injected or topical glucocorticoid
Glucocorticoid-induced adrenal insufficiency is possible.
Evidence
- EV-ES-GCAI-2024 · Beuschlein F, Else T, Bancos I, et al. European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and therapy of glucocorticoid-induced adrenal insufficiency. J Clin Endocrinol Metab. 2024;109(7):1657-1683.
Physician adjudication required. Clinical decision support for physician review. This output identifies laboratory patterns and safety situations. It does not diagnose adrenal insufficiency, name a glucocorticoid dose, or replace emergency treatment. Physician adjudication is required.
Change the values
The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.
Cortisol testing
- <5 very likely
- 5–14.9 indeterminate
- ≥15 unlikely
46 pg/mL is assumed when empty.
Chemistry and vitals
Symptoms and signs
Exposures, history and context
More adrenal cases
ADR-FX-01
Low sodium, high potassium, weight loss and nausea
A 44-year-old with hyperpigmented scars.
ADR-FX-02
Hyperpigmentation and fatigue
No labs yet.
ADR-FX-03
Salt craving and dizziness on standing
Low sodium.
ADR-FX-04
Cortisol 2.1 with ACTH 180
Low cortisol and high ACTH: a primary pattern.
ADR-FX-05
Morning cortisol 9 µg/dL
Indeterminate.
ADR-FX-06
Morning cortisol 17 µg/dL
Unlikely.
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