Vertebral augmentation complicated by perioperative addisonian crisis.
BACKGROUND
We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature.


OBJECTIVE
To report an Addisonian crisis perioperative to vertebral augmentation.


METHODS
Case report.


METHODS
Retrospective case review.


RESULTS
The patient had a history of adrenal insufficiency treated previously with steroids. He developed an L3 vertebral compression fracture, failed conservative therapy and was eventually referred for vertebral augmentation. Immediately after starting the procedure, the patient developed profound hypotension unresponsive to intravenous fluids and vasopressors, consistent with Addisonian crisis. After intravenous steroids had resolved the Addisonian crisis, he underwent vertebral augmentation without further complication.


CONCLUSIONS
Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal insufficiency and treat with intravenous hydrocortisone.
Nemeth
Alexander J
AJ
Division of Neuroradiology, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Boston, MA 02114, USA. anemeth@partners.org
Lie-Nemeth
Theresa J
TJ
Marota
John J A
JJ
Pryor
Johnny C
JC
Rabinov
James D
JD
Hirsch
Joshua A
JA
D000224:Addison Disease / Q000150:complications* / Q000188:drug therapy; D000369:Aged, 80 and over; D050815:Fractures, Compression / Q000150:complications / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology*; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology*; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D008297:Male; D011859:Radiography; D013256:Steroids / Q000008:administration & dosage
D013256:Steroids