Adrenal Crisis as An Adverse Reaction to Zoledronic Acid in a Patient With Primary Adrenal Insufficiency: A Case Report and Literature Review.

Background/Objective: Adrenal crisis is a medical emergency and an acute complication of adrenal insufficiency (AI). It can be triggered by stressors such as infection, dehydration, trauma, or surgery. Case Report: We present a case of a 70-year-old woman with a history of Addison's disease, who presented in adrenal crisis within 24 hours after receiving her first infusion of zoledronic acid. No trigger was identified after extensive evaluation, making infusion with zoledronic acid the most likely cause of adrenal crisis. Discussion: Adverse reactions to medications can potentially trigger adrenal crisis. The present case report demonstrates that intravenous bisphosphonates can cause an acute phase reaction that may lead to adrenal crisis. Given the increased risk of osteoporosis in patients with AI there is an increased likelihood of prescription of intravenous bisphosphonates in this patient population. Conclusion: Patients with AI undergoing infusion with zoledronic acid may require an increased dose of glucocorticoid prior to infusion and may need to undergo monitoring post infusion for possible adrenal crisis.

Alumni Perspectives on the Role of Medical School Service Learning Experiences in Their Professional Development and Practice.

PURPOSE: Understand how participation in service-learning activities in medical school influenced physicians' early careers. METHODS: Researchers conducted semi-structured interviews with physicians who had completed residency training and held leadership positions within an established medical-student-run, service-learning initiative. The research team analyzed the interviews iteratively, using an editing coding strategy to identify categories, and identified themes by prolonged data immersion. The team sought disconfirming evidence and conducted member-checking. Researchers stopped interviews after no new themes emerged (saturation). RESULTS: The research team identified four main themes: service-learning activities provided an outlet for individuals predisposed to service; participants reported actively seeking underserved populations in their practice; participants described increased sensitivity towards the underserved; and participants reported gaining leadership, organizational, and administrative skills. CONCLUSIONS: Physicians who participated in medical school service-learning activities indicated these experiences influenced their professional development and approach to practice. Future studies may consider these outcomes when evaluating service-learning projects.