Perioperative development of Acute Adrenal Insufficiency: A Case Report

Case: A 60-year-old female patient presented to the emergency room with complaints of abdominal pain, nausea and fever. On examination, she was conscious and and cooperative. The temperature was 38.5°C, Glasgow Coma Score 14, blood pressure 135/82 mmHg, heart rate 74bpm, SpO2 97%. The patient was diagnosed with an acute abdomen and referred for an emergency operation. At 35 minutes, the patient developed hypotension (65/34 mmHg), which did not respond to the administration of adequate fluid support and vasoactive-inotropic agents. Blood-gas analysis showed hypoglycemia (50 mg/dl), hyponatremia, and hyperchalemia, which suggested acute adrenal insufficiency. In addition to fluid support and vasoactive-inotropic agents, methylprednisolone (150 mg) and 20% dextrose were initiated. The hemodynamic status of the patient improved and operation was successfully completed.Preoperative anesthetic evaluation should include the history of previous drug use, in particular steroid use. Anesthesiologists should be alert to the signs and symptoms of acute adrenal insufficienc