A 24- to 48-h course of large-dose glucocorticoid therapy is often used in the acute management of spinal cord injury. We describe a patient who developed adrenal insufficiency (AI) after this protocol. Although a definitive causal relationship between the steroids and AI was not established, their temporal association and the exclusion of other possible etiologies led us to postulate that AI was a complication of the steroid protocol. Clinicians should, therefore, consider AI in patients with spinal cord injury receiving glucocorticoids, a population in whom it may otherwise go undiagnosed and untreated.