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Iatrogenic adrenal suppression — SCE Endocrinology MCQ

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HardAdrenalIatrogenic adrenal suppressionSCE Endocrinology

A 43-year-old man with HIV on antiretroviral therapy develops truncal obesity, striae and proximal weakness after repeated intra-articular triamcinolone injections. Morning cortisol is suppressed. What is the underlying pathophysiology?

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Correct answer: B — Reduced steroid clearance causing systemic glucocorticoid exposure

CYP3A4 inhibition by some antiretrovirals can greatly increase systemic exposure to injected or inhaled steroids. The suppressed morning cortisol reflects exogenous glucocorticoid effect and adrenal suppression. Recognition prevents repeated steroid exposure and adrenal crisis during withdrawal.

Reference: BNF; Society for Endocrinology Steroid Guidance