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CPE-008 · synthetic case ADR-FX-13
Hypotension after stopping long-term prednisone
Chronic glucocorticoid exposure and sodium 124.
Purpose: Chronic glucocorticoid exposure and sodium 124.
Inputs the engine received
Chemistry and vitals
- Age
- 71 years
- Sodium
- 124 mmol/L
- Systolic BP
- 82 mmHg
Exposures, history and context
- Glucocorticoid dose, prednisone equivalent
- 7.5 mg/day
- Duration of that dose
- 40 weeks
What the engine reports
Hypotension with a recognized risk for adrenal insufficiency is an emergency. Treat first per protocol and do not wait for test results; draw cortisol and ACTH only if it does not delay treatment. The engine names no dose.
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
Urgent Review Finding
A safety rule calls for urgent clinical assessment. Read the safety findings first.
- Pattern: glucocorticoid induced risk
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Emergency treatment per adrenal-crisis protocol; do not wait for laboratory confirmation.
- 2Do not stop glucocorticoids abruptly; physician to plan any taper, and provide sick-day guidance.ESE/Endocrine Society 2024.
Evidence and rule trace · 2 rules
AI-10Glucocorticoid exposure
Inputs: prednisone equivalent 7.5 mg/day for 40 weeks
Glucocorticoid-induced adrenal insufficiency is possible.
AI-12Possible adrenal crisis
Inputs: systolic blood pressure 82 mmHg · glucocorticoid exposure · sodium 124
Emergency: suspected adrenal crisis.
Evidence
- EV-ES-PAI-2016 · Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389.
- 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.
- EV-RUSHWORTH-2019 · Rushworth RL, Torpy DJ, Falhammar H. Adrenal Crisis. N Engl J Med. 2019;381(9):852-861.
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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