Perioperative development of Acute Adrenal Insufficiency: A Case Report

Yıl 2019, , 5 - 11, 25.02.2019

Serkan Uçkun , Tamer Kuzucuoğlu , Feriha Temizel

https://doi.org/10.33716/bmedj.475420

Öz

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
insufficiency

Anahtar Kelimeler

intraoperative hypotension, adrenal crisis, acute adrenal insufficiency

Ameliyat esnasında gelişen Akut Adrenal Yetmezlik: Olgu Sunumu

Öz

Olgu: 60 yaşında kadın hasta; karın ağrısı,
kusma ve ateş şikayetleriyle acil servise başvurdu. Muayenesinde bilinç açık,
koopereydi. Ateş 38.5C, Glaskov koma skoru 14, kan basıncı 135/82 mmHg, kalp
atım hızı 74/dakika, SpO2 %97 idi. Hasta akut batın tanısıyla acil operasyona
alındı. Operasyonun 35. Dakikasında yeterli sıvı desteği ve vazoaktif-inotrop
ilaçlara yanıtsız hipotansiyon (65/34) gelişti. Kan gazında gözlenen
hipoglisemi (50mg/dl), hiponatremi ve hiperpotasemi Akut Adrenal
Yetmezliği  destekledi. Hastaya ek olarak
metilprednizolon (150 mg) ve %20 Dekstroz başlandı. Hemodinamik olarak düzelen
hastanın operasyonu başarılı bir şekilde tamamlandı. Sonuç olarak; preoperatif
anestezik değerlendirme ilaç kullanımı ve özellikle steroid ilaçları
içermelidir. Anesteziyologlar, Akut Adrenal Yetmezlik belirti ve semptomlarını
gözden kaçırmamalıdırlar.

Anahtar Kelimeler

intraoperatif hipotansiyon, adrenal kriz, akut adrenal yetmezlik

Kaynakça

• 1-RC, Koshy, Rajasree,M.Thomas. Anaesthetic Management of a Patient with Sarcoidosis Presenting for Mastectomy.J Anaesthesio l Clin Pharmacol. 2010 ; 26(4): 555–556.2-Varan Ö, Gürlek A. Adrenal Yetmezlik, Tanı ve Tedavi Algoritması. A Sistemik Review. Yoğun Bakım Dergisi 2010; 9(4):200-73-Hamrahian AH, Fleseriu M, AACE Adrenal Scientific Committee. Evaluatıon and management of adrenal insuffıcıency in critically ill patients: disease state review. Endocr Pract. 2017 Jun;23(6):716-725. 4-Doğu B, Öksüz H, Şenoğlu N, Yavuz C, Gişi G. Ameliyat Sonrası Ani Hipotansiyonla Ortaya Çıkan Rölatif Adrenal Yetersizlik. Turk J Anaesth Reanim 2014; 42: 283-75-Bendel S, Karlsson S, Pettilä V, Loisa P, Varpula M, Ruokonen E; Finni sepsis Study Group. Free cortisol in sepsis and septic shock. Anesth Analg 2008; 106: 18136-Mazziotti G, Formenti AM, Frara S, Roca E, Mortini P, Berruti A, Giustina A. Management of endocrıne dısease: rısk of overtreatment of patıents wıth adrenal ınsuffıcıency: current and emergıng aspects. Eur. J. Endocrinol. 20177-Huecker MR, Dominique E .Adrenal Insufficiency.Treasure Island (FL): StatPearls Publishing; 2017.8-Pazderska A, Pearce SH. Adrenal insufficiency recognition and management. Clin Med (Lond) 2017 Jun;17(3):258-262.9-Guerrero Pérez , Marengo AP, Villabona Artero C. The unresolved riddle of glucocorticoid withdrawal. J. Endocrinol. Invest. 2017; 40(11):1175-118110-Flück CE. Mechanisms in endocrinology: Update on pathogenesis of primary adrenal insufficiency: beyond steroid enzyme deficiency and autoimmune adrenal destruction. Eur. J. Endocrinol. 2017 Sep;177(3):99-111.11-Lee YY, Cho NH, Lee JW, Kim NK, Kim HS, Kim MK. Clinical Characteristics of Patients with Adrenal Insufficiency in a General Hospital. Endocrinol Metab (Seoul) 2017 Mar;32(1):83-89. 12-Rushworth RL, Torpy DJ, Falhammar H. Adrenal crises: perspectives and research directions. Endocrine. 2017 Feb;55(2):336-345.