Adrenal Crisis: From Perioperative Clinic to Diagnosis

Adrenal crisis, a life-threatening complication of adrenal insufficiency, can present perioperatively with refractory hypotension and electrolyte imbalances. This case report describes a 77-year-old woman with multiple comorbidities who developed intraoperative shock unresponsive to high-dose vasopressors during aortobifemoral bypass surgery. Persistent hypokalemia and hypoglycemia raised suspicion of adrenal insufficiency, prompting empiric intravenous (IV) methylprednisolone (75 mg), which rapidly resolved hypotension and obviated further inotropic support. The case underscores the importance of considering adrenal crisis in perioperative refractory hypotension, even without prior diagnosis. Early glucocorticoid administration, prior to confirmatory laboratory results, is critical to prevent mortality.