Adrenal insufficiency due to everolimus: a case report

• Autor: Hernández Navas, Jorge Andrés
• Formato: artículo
• Fecha de Publicación: 2025
• Institución: Universidad de San Martín de Porres
• Repositorio: Horizonte médico
• Lenguaje: español
• OAI Identifier: oai:horizontemedico.usmp.edu.pe:article/3017
• Enlace del recurso: https://www.horizontemedico.usmp.edu.pe/index.php/horizontemed/article/view/3017
• Nivel de acceso: acceso abierto
• Materia: Endocrinology; Everolimus; Immunosuppressive Agents; Liver Transplantation; Insuficiência adrenal, everolimus, imunossupressores, transplante de fígado; Endocrinología; Inmunosupresores; Trasplante Hepático

Although rare, secondary adrenal insufficiency represents a serious complication in patientsreceiving treatment with mTOR inhibitors, such as everolimus. This drug is commonly used toprevent organ transplant rejection and to treat certain cancer types, but its impact on adrenalfunction is not always apparent. In the case presented, a 74-year-old man with a history of livertransplant and type 2 diabetes mellitus attended his routine medical check-up with no symptomsrelated to adrenal insufficiency. Despite his asymptomatic state, the medical team decided tostudy adrenal function because of the prolonged duration of everolimus treatment. The diagnostictests included the measurement of 24-hour urine cortisol, which revealed low cortisol levels,thus confirming adrenal insufficiency. This finding is significant, as adrenal insufficiency can resultin adrenal crises that, if not properly managed, can be potentially fatal. This case highlightsthe importance of endocrine surveillance in immunosuppressed patients, where the absence ofsymptoms should not lead to complacency. A proactive approach to evaluating adrenal functionis crucial for identifying complications before they become emergencies. Early detection andappropriate treatment of adrenal insufficiency can significantly improve clinical outcomes and thequality of life for these patients. Therefore, it is recommended that physicians remain vigilantto the risks associated with the use of mTOR inhibitors and conduct regular adrenal functionevaluations in this patient group.