SECONDARY ADRENAL INSUFFICIENCY IN LUPUS NEPHRITIC WITH CORTICOSTEROID THERAPY Yosyi Oktahara, Aditiawati, Hertanti Indah Lestari* Department

of Child Health, Faculty of edicine, !riwi"aya #ni$ersity Dr% ochammad Hoesin Hospital &alem'an( A'stract Background Adrenal insufficiency is caused 'y impairment of pituitary (land or hypothalamus% )he most common secondary adrenal insufficiency is caused 'y e*o(enous steroid use% )he serious complication is adrenal crisis% Objec !"e )o descri'e secondary adrenal insufficiency in a children with lon( term corticosteroid therapy for nephrotic ran(e lupus nephritic% Ca#e A +, years old 'oy was admitted to our pediatric department with complaints fati(ue, nausea and a(itation% He has 'een dia(nosed nephrotic ran(e lupus nephritic since - months 'efore% He treated with full dose corticosteroid . m(/0(/day% Ad$erse effects has already appear in short time such as se$ere hypertension and striae hyper1pi(mentation% Corticosteroid dose reduced to + m(/0(/day for 2 weeks and then tapper off + ta'/week% !ymptoms of fati(ue, nausea, hypo(lycemia, loss of appetite and a(itation appears se$eral time if dose decrease 'elow ,,.3 m(/k(% As note he also (ot wei(ht loss from 34 k( to 2, k( durin( - months, and his mother has dia'etic history% La'oratory e$aluation shows low Cortisol serum in mornin( -,5 6(/dl 7ref 8,.1+9 6(/dl:, and 2 6(/dl in afternoon 7ref .,-1++,9 6(/dl:% C1peptide results is 5,54 m(/dl 7ref +,+12,2 m(/dl: that shows hyper1 insulin as the compensation of hypo(lycemia, whereas electrolyte is normal% )he patient is still treat with corticostreroid lowest dose that don;t make symptoms until now% Conc$u#!on !econdary adrenal insufficiency is re$ersi'le serious side effect of corticosteroid therapy% &ro(nosis is depend on H&A a*is suppression, corticosteroid treatment and patient monitorin(% AC)H stimulation test and O<) )est should 'e done to this patient% %e&'ord# Adrenal insufficiency, corticosteroid, lupus nephritic, nephrotic syndrome