[Bilateral ossification of the earlobes. Addisonian crisis in the postoperative period]

Case report. A 53 year-old male patient was scheduled for surgical resection of biliary lithiasis and correction of anal fistula. He had previous history of repetitive biliary colics and appendicectomy at the age of 34 with undetermined anesthetic complications. Under epidural anesthesia with 270 mg of mepivacaine at the L1-L2 level cholecystectomy and fistulectomy was performed with any immediate surgical or postoperative complication. Eighteen hours after surgery the patient presented clinical signs of shock with systolic arterial pressure between 40 and 50 mmHg. This clinical situation associated with the finding of hard ear auricles with radiologic signs of calcification allowed to suspect the presence of an addisonian crisis. Clinical recovery was obtained with corticosteroid therapy: a bolus of 500 mg of methylprednisolone followed by 40 mg every 8 hours. The postoperative period was therefore uneventful. Examination of suprarenal function demonstrated the presence of Addison disease. Calcification of ear auricles is an uncommon clinical sign which is associated to local traumatisms, gout, and several endocrine diseases. The presence of ear auricle calcification in postoperative patients with shock should lead to consider the possibility of addisonian crisis.