title: Relative adrenal insufficiency manifested with multiple organ dysfunction in a liver transplant patient.
abstract: Relative adrenal insufficiency is now a well-known clinical condition that occurs in critically ill patients particularly with septic complication. However, this pathology has long been unrecognized until recently in liver transplantation patients, for whom postoperative immunosuppressive therapies almost always comprise corticosteroids. We report an obvious case of relative adrenal insufficiency manifested by severe multiple organ dysfunction in a recipient after living donor liver transplantation (LDLT). A 38-year-old woman with multiple hepatocellular carcinoma developed refractory liver failure 2 months after the completion of the dual treatment; namely a cytoreductive right hepatectomy for bulky main tumors followed by 2 courses of percutaneous isolated hepatic perfusion for residual tumors in the remnant liver. She underwent a right-lobe LDLT, and postoperative immunosuppression was initiated with a low-dose tacrolimus monotherapy without corticosteroid because of a severe septic condition before transplantation. Postoperatively, she developed progressive hyperbilirubinemia, renal dysfunction, and coagulopathy. As the corticotropin stimulation test suggested the relative adrenal insufficiency, corticosteroid was commenced 40 days after LDLT. Thereafter, multiple organ dysfunction resolved dramatically and promptly. The patient is presently alive and well with completely normalized liver function 45 months after LDLT.
authors.affiliation: Department of Liver Surgery and Transplantation, Kobe University Graduate School of Medicine, Kobe, Japan. iwasaki@med.kobe-u.ac.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Nobuya
authors.initials: N
authors.lastname: Kusunoki
authors.forename: Takemi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ogata
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D016031:Liver Transplantation; D008775:Methylprednisolone / Q000627:therapeutic use; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000188:drug therapy*; D011860:Radiography, Abdominal; D016559:Tacrolimus / Q000627:therapeutic use; D036542:Tomography, Spiral Computed
chemical_list: D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D016559:Tacrolimus; D008775:Methylprednisolone