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[Perioperative Addisonian crisis].

C Martin1, T Steinke, M Bucher

  • 1Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland. christoph.martin@uk-halle.de

Der Anaesthesist
|June 15, 2012
PubMed
Summary

An Addisonian crisis, an acute adrenal failure, can occur after abrupt glucocorticoid withdrawal. This case highlights a Crohn's patient's crisis during surgery following self-discontinued prednisolone.

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Area of Science:

  • Endocrinology
  • Gastroenterology
  • Surgical Critical Care

Background:

  • Addisonian crisis is acute adrenocortical insufficiency, often triggered by stress or abrupt glucocorticoid cessation.
  • Long-term glucocorticoid use, like prednisolone for Crohn's disease, can suppress the hypothalamic-pituitary-adrenal axis.
  • Patients on chronic steroids are at risk for adrenal crisis, especially during surgical stress.

Observation:

  • A 25-year-old Crohn's patient experienced an Addisonian crisis during emergency laparotomy.
  • The crisis was precipitated by the patient's self-initiated termination of prednisolone.
  • Symptoms included hypotension, hyponatremia, and hypoglycemia, requiring intensive management.

Findings:

  • Aggressive fluid resuscitation, hydrocortisone, glucose, and catecholamines were initiated.
  • Hemodynamic stabilization was achieved with the initial intensive treatment.
  • Reducing hydrocortisone led to recurrent cardiovascular insufficiency, necessitating increased dosage.

Implications:

  • This case underscores the critical need for careful glucocorticoid management in patients with inflammatory bowel disease undergoing surgery.
  • Abrupt steroid cessation in patients with suppressed adrenal function can precipitate life-threatening adrenal crisis.
  • Maintaining adequate glucocorticoid coverage is vital during surgical procedures for patients on long-term steroid therapy.