![]() Hydrocortisone substitution therapy was started, which led to normalization of all muscular, articular, and biological abnormalities in 48 hours. ![]() ![]() Complementary tests showed a very low baseline cortisol cycle, pathologic adrenocortical stimulation, and elevated plasma adrenocorticotropic hormone levels, demonstrating adrenal atrophy caused by long-term corticosteroid therapy. The fibrates were stopped 1 month later, without any clinical and biological benefit. Creatine kinase level was elevated at 438 U/L (reference, <230 U/L), with myoglobin at 117 μg/L (reference, <90 μg/L). His erythrocyte sedimentation rate was 13 mm/h during the first hour, and his C-reactive protein level was decreased at 9 mg/L. Laboratory blood tests were normal, as were tests of renal and liver function. His reflexes were symmetrical but diminished. Muscular pain in the arms, legs, and trunk were aggravated by palpation. Clinical examination revealed a normal blood pressure without orthostatic hypotension. Six weeks later, he became progressively fatigued, with articular pain and diffuse myalgias with muscular weakness.
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