title: Anesthetic management of emergent laparoscopic bilateral adrenalectomy in a patient with a life-threatening cortisol crisis.
abstract: Cushing syndrome may rarely present with life-threatening hypercortisolism, manifested by hypertension, hypokalemia, hyperglycemia, and edema. If medical treatment proves ineffective in ameliorating the symptoms, emergent rescue adrenalectomy may be the only way to relieve the crisis. We describe the anesthetic management of a patient with an ectopic adrenocorticotropic hormone-secreting tumor, whose condition was rapidly deteriorating due to severe cortisol excess, and emergent adrenalectomy was the only available therapeutic modality. Despite severe metabolic derangement, edema, and incipient respiratory failure, emergent bilateral laparoscopic adrenalectomy was performed and the patient improved sufficiently to undergo surgery for the ectopic lesion without incident.
authors.affiliation: From the *Departments of Anesthesia, †Surgical Disciplines, ‡Anesthesiology, and §Endocrinology, All India Institute Medical Sciences, New Delhi, India.
authors.forename: Ankur
authors.initials: A
authors.lastname: Sharma
authors.forename: Rajeshwari
authors.initials: R
authors.lastname: Subramaniam
authors.forename: Mahesh
authors.initials: M
authors.lastname: Misra
authors.forename: Bandi
authors.initials: B
authors.lastname: Joshiraj
authors.forename: Gopi
authors.initials: G
authors.lastname: Krishnan
authors.forename: Prerna
authors.initials: P
authors.lastname: Varma
authors.forename: Shyam
authors.initials: S
authors.lastname: Kishore
mesh_terms: D000182:ACTH Syndrome, Ectopic / Q000601:surgery; D000315:Adrenalectomy; D000324:Adrenocorticotropic Hormone / Q000097:blood / Q000378:metabolism; D000777:Anesthetics; D016638:Critical Illness; D003480:Cushing Syndrome / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D004487:Edema / Q000175:diagnosis; D005045:Etomidate; D005283:Fentanyl; D006801:Humans; D006854:Hydrocortisone / Q000097:blood / Q000378:metabolism; D007008:Hypokalemia / Q000175:diagnosis; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000777:Anesthetics; D000324:Adrenocorticotropic Hormone; D005283:Fentanyl; D006854:Hydrocortisone; D005045:Etomidate