title: Catecholamine-resistant shock and hypoglycemic coma after cardiotomy in a patient with unexpected isolated ACTH deficiency.
abstract: Isolated adrenocorticotropic hormone (ACTH) deficiency is an extremely rare disease in which ACTH-producing cells of the pituitary gland are selectively damaged. The resulting decline in ACTH production and secretion results in chronic secondary adrenocortical insufficiency. The patient in this case did not present with adrenal insufficiency symptoms prior to surgery. However, after cardiotomy under extracorporeal circulation, the patient lapsed into a catecholamine-resistant shock and hypoglycemic coma. Acute adrenal insufficiency was strongly suspected, and the patient was diagnosed with isolated ACTH deficiency after careful examination. Because the demand for cortisol increases after highly invasive surgeries, cortisol supplementation therapy is essential for patients with complications from isolated ACTH deficiency. There is a high risk of a lethal outcome when surgery is carried out without a diagnosis, as in this case. Therefore, cortisol must be supplemented without delay when acute adrenal insufficiency is suspected during the perioperative period.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka-Hasamamachi, Yufu, Oita, 879-5593, Japan. sigekiyo@oita-u.ac.jp
authors.forename: Shigekiyo
authors.initials: S
authors.lastname: Matsumoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hagiwara
authors.forename: Junya
authors.initials: J
authors.lastname: Kusaka
authors.forename: Rie
authors.initials: R
authors.lastname: Hasegawa
authors.forename: Hitomi
authors.initials: H
authors.lastname: Nonaka
authors.forename: Chihiro
authors.initials: C
authors.lastname: Shingu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Noguchi
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications / Q000188:drug therapy; D000309:Adrenal Insufficiency / Q000150:complications*; D000758:Anesthesia; D001784:Blood Gas Analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D002395:Catecholamines / Q000627:therapeutic use*; D002908:Chronic Disease; D003926:Diabetic Coma / Q000188:drug therapy / Q000209:etiology*; D004351:Drug Resistance; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery; D010901:Pituitary Function Tests; D011183:Postoperative Complications / Q000188:drug therapy*; D011188:Potassium / Q000097:blood; D011229:Preanesthetic Medication; D012769:Shock / Q000188:drug therapy / Q000209:etiology*; D012964:Sodium / Q000097:blood
chemical_list: D002395:Catecholamines; D012964:Sodium; D011188:Potassium; D006854:Hydrocortisone