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.

journal_name

J Anesth

journal_title

Journal of anesthesia

authors

Matsumoto S,Hagiwara S,Kusaka J,Hasegawa R,Nonaka H,Shingu C,Noguchi T

doi

10.1007/s00540-011-1118-3

subject

Has Abstract

pub_date

2011-06-01 00:00:00

pages

431-4

issue

3

eissn

0913-8668

issn

1438-8359

journal_volume

25

pub_type

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