Vertebral augmentation complicated by perioperative addisonian crisis

Area of Science:

• Endocrinology
• Neurosurgery
• Orthopedic Surgery

Background:

• Vertebral augmentation is a common procedure for vertebral compression fractures.
• While generally safe, potential complications exist, though Addisonian crisis has not been previously reported.

Observation:

• A patient with a history of adrenal insufficiency developed profound hypotension during vertebral augmentation.
• The hypotension was unresponsive to standard fluid and vasopressor treatment, indicating an Addisonian crisis.

Findings:

• The patient's Addisonian crisis resolved promptly after administration of intravenous steroids.
• Vertebral augmentation was successfully completed without further complications after the crisis was managed.

Implications:

• Vertebral augmentation may precipitate Addisonian crisis in susceptible patients.
• Clinicians must maintain a high index of suspicion for adrenal insufficiency in patients undergoing vertebral augmentation.
• Immediate treatment with intravenous hydrocortisone is essential for managing perioperative Addisonian crisis.