# Severe Short Stature, Pathological Fracture, and Avascular Necrosis Due to Prolonged Over-the-Counter Steroid Use in an Adolescent Patient

## TL;DR

A teenager's long-term unsupervised use of over-the-counter steroids caused severe health issues, including bone fractures and growth problems.

## Contribution

This case highlights the rare but severe endocrinopathies caused by prolonged unsupervised steroid use in adolescents.

## Key findings

- Prolonged OTC prednisolone use led to severe osteoporosis, avascular necrosis, and growth failure.
- The patient exhibited suppressed cortisol levels and delayed puberty due to adrenal insufficiency.
- Unregulated steroid use in adolescents can result in irreversible musculoskeletal and endocrine damage.

## Abstract

Glucocorticoids (GCs) are widely prescribed for their anti-inflammatory and immunosuppressive properties; however, prolonged, unsupervised, or over-the-counter (OTC) use, particularly during childhood and adolescence, can have profound consequences. We present a case of an 18-year-old male patient with a 10-year history of self-medicating with oral prednisolone for joint pain, without medical supervision. He presented with severe hip pain and difficulty ambulating. Examination revealed classical Cushingoid features, severe short stature, and delayed puberty. Pelvic radiographs revealed a pathological fracture of the left femoral neck and avascular necrosis (AVN) of the right femoral head. A dual-energy X-ray absorptiometry (DXA) scan demonstrated severe osteoporosis. Hormonal evaluation revealed suppressed 8:00 AM serum cortisol, consistent with secondary adrenal insufficiency. This case underscores the devastating consequences of unregulated GC use during adolescence, resulting in growth failure, delayed puberty, osteoporosis, adrenal insufficiency, and AVN. It highlights the need for clinician vigilance, public education, and policy-level regulation of OTC steroid access to prevent such avoidable endocrinopathies.