Adrenal insufficiency due to everolimus: a case report

Abstract

Although rare, secondary adrenal insufficiency represents a serious complication in patients
receiving treatment with mTOR inhibitors, such as everolimus. This drug is commonly used to
prevent organ transplant rejection and to treat certain cancer types, but its impact on adrenal
function is not always apparent. In the case presented, a 74-year-old man with a history of liver
transplant and type 2 diabetes mellitus attended his routine medical check-up with no symptoms
related to adrenal insufficiency. Despite his asymptomatic state, the medical team decided to
study adrenal function because of the prolonged duration of everolimus treatment. The diagnostic
tests 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 result
in adrenal crises that, if not properly managed, can be potentially fatal. This case highlights
the importance of endocrine surveillance in immunosuppressed patients, where the absence of
symptoms should not lead to complacency. A proactive approach to evaluating adrenal function
is crucial for identifying complications before they become emergencies. Early detection and
appropriate treatment of adrenal insufficiency can significantly improve clinical outcomes and the
quality of life for these patients. Therefore, it is recommended that physicians remain vigilant
to the risks associated with the use of mTOR inhibitors and conduct regular adrenal function
evaluations in this patient group.