title: Acute adrenal crisis after orthopedic surgery for pathologic fracture.
abstract: BACKGROUND
  Adrenal crisis after surgical procedure is a rare but potentially catastrophic life-threatening event. Its manifestations, such as hypotension, tachycardia, hypoxia, and fever mimic the other more common postoperative complications. Clinical outcome is dependent upon early recognition of the condition and proper management with exogenous steroid administration.
  
  
  METHODS
  We report a 75-year-old man who presented with shock immediately after surgery for a femoral fracture from lung cancer metastasis. Anemia and severe hyponatremia were detected. Despite adequate fluid resuscitation, nonspecific symptoms including hypotension, tachycardia, hypoxia, fever and confusion occurred. Emergent CT revealed enlarged bilateral adrenal glands. Under the diagnosis of adrenal crisis due to metastatic infiltration of adrenal glands, the patient was treated with appropriate steroid replacement resulting in rapid improvement and recovery.
  
  
  CONCLUSIONS
  We describe a case of adrenal crisis caused by the lack of adrenal reserve based on metastatic involvement and surgical stress, the first published case of adrenal crisis after surgery for a pathologic fracture from lung cancer metastasis. Surgeons treating pathologic fractures should be aware of this complication and familiar with its appropriate therapy because of increasing opportunity to care patients with metastatic bone tumors due to recent advances in cancer treatment.
authors.affiliation: Department of Orthopedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan. naka-no@mc.pref.osaka.jp
authors.forename: Norifumi
authors.initials: N
authors.lastname: Naka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takenaka
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Nanno
authors.forename: Yu
authors.initials: Y
authors.lastname: Moriguchi
authors.forename: Bang-mi
authors.initials: BM
authors.lastname: Chun
authors.forename: Shunji
authors.initials: S
authors.lastname: Sonoda
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Yoshitane
authors.initials: Y
authors.lastname: Tsukamoto
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Araki
mesh_terms: D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects* / Q000379:methods; D001859:Bone Neoplasms / Q000150:complications / Q000556:secondary*; D005265:Femoral Neck Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D005500:Follow-Up Studies; D005598:Fractures, Spontaneous / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy; D035583:Rare Diseases; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones