Acute Adrenal Insufficiency Induced by Total Body Irradiation in a Recipient of an Allogeneic Hematopoietic Stem Cell Transplantation

Radiotherapy used in the treatment of malignant disorders has been associated with the late emergence of chronic adrenal insufficiency. Reported here is an 18 years old male with acute lymphoblastic leukemia who received an allogeneic hematopoietic stem cell transplant following a conditioning therapy composed of total body irradiation and cyclophosphamide at King Faisal Specialist Hospital and Research Centre in Riyadh in October 2008. Four days following his allograft, the patient developed acute hypoadrenalism that responded well to corticosteroid replacement therapy. To our knowledge, this is the first case of radiation-induced acute adrenal insufficiency. In certain individuals who have specific risk factors for the development of hypoadrenalism, radiotherapy may precipitate Addisonian crisis which requires prompt diagnosis and urgent therapy.