Case of addison’s disease secondary to steroid non - adherance in psoriatic patient in a rural hospital

Background: Secondary adrenal insufficiency is a rare condition in which the adrenal glands fail to produce sufficient cortisol and aldosterone, commonly referred to as Addison’s disease. We report a case of Addison’s disease coexisting with chronic plaque psoriasis, both requiring medical management. Case Pr esentation: A 40 - year - old male patient was admitted to the ICU with a known history of chronic plaque psoriasis. He had been undergoing long - term corticosteroid therapy (dexamethasone and betamethasone) for approximately four months, which he abruptly disc ontinued one week prior to admission. He presented with symptoms of easy fatigability, reduced appetite, and persistent vomiting. Laboratory tests revealed abnormal cortisol and ACTH levels. Contrast - enhanced CT (CECT) of the abdomen and pelvis showed bila terally atrophic adrenal glands, likely secondary to a chronic autoimmune disorder. Based on these findings, a diagnosis of secondary adrenal insufficiency was confirmed. The patient responded well to steroid replacement therapy with hydrocortisone. Conclu sion: This case report highlights steroid - induced secondary adrenal insufficiency presenting as Addison’s disease in a patient with chronic plaque psoriasis. Prolonged unsupervised use of oral dexamethasone and betamethasone led to HPA axis suppression, co nfirmed by low ACTH levels and bilateral adrenal atrophy. Delayed diagnosis due to limited rural healthcare access emphasizes the importance of awareness and monitoring in long - term steroid users. Lifelong follow - up, medication adherence, and supervised ta pering are essential to prevent recurrence.