title: Adrenal insufficiency presenting as bilateral rigid auricles: a case report.
abstract: BACKGROUND
  Stiff ears appear to be a warning sign for adrenal insufficiency. This remarkable and rare sign has not been described to present in adrenal insufficiency in the setting of critical care.
  
  
  METHODS
  We present the case of a 68-year-old Caucasian male who underwent a thymoma resection and suffered from preoperative weight loss and lack of strength. The perioperative phase was characterised by hypotension and sputum stasis due to muscle weakness, which caused two readmissions to the intensive care unit. His physical examination showed two fully rigid auricles. In retrospect, our patient suffered from secondary adrenal insufficiency and hypogonadism.
  
  
  CONCLUSIONS
  The bilateral rigid auricles appeared to be a warning sign for adrenal insufficiency. This remarkable sign is easily checked, and should prompt a higher index of suspicion towards adrenal insufficiency and other hormonal deficiencies.
authors.affiliation: Department of Anaesthesiology, Erasmus University Medical Center, Postbus 2040, 3000, CA Rotterdam, The Netherlands. m.koning@erasmusmc.nl.
authors.forename: Mark Vincent
authors.initials: MV
authors.lastname: Koning
authors.forename: Ard
authors.initials: A
authors.lastname: Struijs
mesh_terms: D000309:Adrenal Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D054644:Ear Auricle / Q000000981:diagnostic imaging*; D004427:Ear Diseases / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006854:Hydrocortisone / Q000627:therapeutic use; D008297:Male; D009999:Ossification, Heterotopic / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D000893:Anti-Inflammatory Agents; D006854:Hydrocortisone