[Perioperative Addisonian crisis].
An Addisonian crisis marks an acute adrenocortical failure which can be caused by decompensation of a chronic insufficiency due to stress, an infarct or bleeding of the adrenal cortex and also abrupt termination of a long-term glucocorticoid medication. This article reports the case of a 25-year-old patient with Crohn's disease who suffered an Addisonian crisis with hypotension, hyponatriemia and hypoglycemia during an emergency laparotomy after he had terminated prednisolone medication on his own authority. This necessitated an aggressive volume therapy in addition to an initial therapy with 100 mg hydrocortisone, 8 g glucose and a continuous administration of catecholamines. Under this treatment regimen hemodynamic stabilization was achieved. Reduction of the administration of hydrocortisone after 3 days resulted in cardiovascular insufficiency which required an escalation of the hydrocortisone substitution.
Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Halle (Saale), Ernst-Grube-Str. 40, 06120, Halle, Deutschland. christoph.martin@uk-halle.de
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D000224:Addison Disease / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D000304:Adrenal Cortex Function Tests; D000328:Adult; D000758:Anesthesia; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D001810:Blood Volume; D002395:Catecholamines / Q000627:therapeutic use; D003422:Critical Care; D016638:Critical Illness; D003424:Crohn Disease / Q000601:surgery; D005440:Fluid Therapy; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D007431:Intraoperative Complications / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D007813:Laparotomy; D008297:Male; D011239:Prednisolone / Q000009:adverse effects; D014883:Water-Electrolyte Imbalance / Q000150:complications / Q000628:therapy
D000893:Anti-Inflammatory Agents; D002395:Catecholamines; D011239:Prednisolone; D006854:Hydrocortisone