Addisonian crisis following osteoprotective therapy in a patient with secondary adrenal insufficiency

Abstract Addisonian crisis secondary to parenteral therapy with zoledronic acid has been rarely reported in the literature. The case report herein presents a case of a 27-year-old female patient with a known history of panhypopituitarism and secondary adrenal insufficiency who developed an Addisonian crisis following her first intravenous infusion of zoledronic acid. This highlighted the role of zoledronic acid as a potential trigger. This is probably mediated by an acute-phase reaction with the lack of a sufficient cortisol response. Therefore, close monitoring of patients with adrenal insufficiency undergoing osteoprotective therapy, at least during the first administration, is indeed recommended.