Perioperative adrenal insufficiency presenting as refractory hypotension: A CARE-compliant article.
Ye Sull Kim, Seung Park, Yejin Song et al.
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Case in brief
A 77-year-old woman undergoing lumbar fusion surgery experienced severe hypotension that did not respond to fluid resuscitation or vasopressors. Her history included discontinued corticosteroid therapy for rheumatoid arthritis nearly 30 years prior and extreme skin fragility. Postoperative administration of intravenous hydrocortisone led to rapid stabilization of her hemodynamics, allowing for the weaning of vasopressors, and she was discharged without complications.
Diagnostic / clinical pearl
Clinicians should consider adrenal insufficiency in patients with unexplained, vasopressor-resistant hypotension, particularly those with a history of corticosteroid use, regardless of how long ago it was discontinued.