Mild liver injury following withdrawal of long-term prednisone therapy: A case report

Table 1 Characteristics of reported cases of liver injury following adrenal sufficiency due to glucocorticoid withdrawal

Ref.	Age (year)	Sex	Glucocorticoid used	Duration of glucocorticoid use	Clinical manifestations	Electrolyte disturbance	Abnormal hepatic function indexes at admission	Initial serum cortisol at 8:00 am/ACTH levels	Time from symptom onset to diagnosis	Treatment	Outcome
Li et al[8]	65	Female	Prednisone 20-40 mg/day	> 2 years	Nausea, vomiting, fatigue, anorexia, pitting edema of lower limbs, jaundice	Hypokalemia, hyponatremia, hypochloremia	Increased ALT (89 U/L; normal range: 3-35 U/L), AST (174 U/L; normal range: 13-35 U/L), total bilirubin, and direct bilirubin and decreased albumin	Cortisol: 42.12 (118.6-618) nmol/L; ACTH: 1.23 (< 10.2) pmol/L	6 months	Intravenous hydrocortisone 30 mg/d for 5 days, followed by oral methylprednisolone 6 mg/day	Fully recovered and remained healthy on hormone therapy over 1-year follow-up
Vafaeimanesh et al[5]	39	Female	Dexamethasone (unknown dose)	Long time	Drowsiness, severe fatigue	Slight decrease in total calcium	Significantly increased ALT (2339 U/L; normal range: 7-41 U/L) and AST (2002 U/L; normal range: 12-38 U/L)	Cortisol: 2.5 μg/dL; ACTH: 11 (9-52) μg/dL	3 days	Prednisone therapy for 12 days	Liver function normalized, and the patient was discharged in good health
Present case	42	Male	Prednisone 30 mg/day initially, gradually tapered to 5 mg/day	Approximately 2 years	Fatigue, decreased appetite, abdominal distention, sweats	No	Slightly increased ALT (125 U/L; normal range: 9-50 U/L) and AST (80 U/L; normal range: 9-50 U/L)	Cortisol: 5.49 (8.7-22) μg/dL; ACTH: 25.41 (7.5-58) μg/dL	10 days	Intravenous compound diisopropylamine dichloroacctate and compound glycyrrhizin for 1 week	Fully recovered from both hospitalizations and is still healthy as of this writing

ACTH: Adrenocorticotropic hormone; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.