Continuous subcutaneous hydrocortisone infusion causing refractory hypokalemia

Central adrenal insufficiency is a life-threatening medical condition that requires the administration of exogenous glucocorticoids. However, because glucocorticoid replacement therapy does not mimic the endogenous circadian cortisol cycle, it may cause patients to feel subjectively unwell. Thus, new therapies such as continuous subcutaneous hydrocortisone infusion (CSHI) are being developed for patients who fail to respond to oral therapy or whose quality of life is reduced. Currently, CSHI therapy is not approved by the Food and Drug Administration. This case study focused on a middle-aged woman who was on long-term oral glucocorticoid therapy for central adrenal insufficiency, had recently switched to CSHI therapy, and is currently experiencing refractory hypokalemia. This complication has not been previously reported.