with normal GH 1.1 ng/ml (RR <6.0 ng/ml). Thyroid function profile revealed TSH 0.83 mIU/l (RR 0.27–4.20 mIU/l) and a mildly low free thyroxine (T4) 10.7 pmol/l (RR 12.0–25.0 pmol/l), likely representing a sick euthyroid syndrome in the setting of nonthyroidal illness.The cause of his secondary adrenal insufficiency was considered to be the methadone opioid analgesia commenced in the 6th week of his hospital admission, then maintained owing to neuropathic pain. He had not exhibited clinical signs of adrenal insufficiency during the course of his preceding ICU admission, and he had not received any previous glucocorticoid. The subsequent development of hypercalcaemia in the 6th week of his hospital admission was the presenting feature of his adrenal insufficiency.
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