Lundy Jonathan B, Slane Matthew L, Frizzi James D
General Surgery Service, Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA 30905-5650, USA.
J Intensive Care Med. 2007 Mar-Apr;22(2):111-7. doi: 10.1177/0885066606298140.
Acute adrenocortical insufficiency is a critical care emergency characterized by hemodynamic instability, lethargy, and cardiovascular collapse. Acute adrenal insufficiency has many etiologies, from rapid withdrawal of exogenous glucocorticoids to adrenocortical destruction to poor adrenal reserve after administration of steroid synthesis inhibitors. Etomidate, a parenteral hypnotic agent, is a steroid synthesis inhibitor. Although the use of continuous etomidate infusion in the intensive care unit fell from favor secondary to reports of adrenal crisis, single-dose etomidate for induction of anesthesia is common for the hemodynamically unstable patient or in patients who may not tolerate wide variance in heart rate or blood pressure. A case is presented of acute adrenocortical insufficiency and crisis after a standard induction dose of etomidate. Acute adrenal insufficiency should be suspected in intensive care unit patients who have undergone general anesthesia with etomidate induction and present with hypotension refractory to standard vasopressor administration.
急性肾上腺皮质功能不全是一种危重症护理紧急情况，其特征为血流动力学不稳定、嗜睡和心血管衰竭。急性肾上腺功能不全有多种病因，从外源性糖皮质激素的快速撤药到肾上腺皮质破坏，再到使用类固醇合成抑制剂后肾上腺储备不足。依托咪酯是一种胃肠外催眠剂，是一种类固醇合成抑制剂。尽管由于肾上腺危象的报告，重症监护病房中持续输注依托咪酯的使用已不再受青睐，但对于血流动力学不稳定的患者或可能无法耐受心率或血压大幅波动的患者，单剂量依托咪酯用于麻醉诱导很常见。本文介绍了一例在给予标准诱导剂量依托咪酯后发生急性肾上腺皮质功能不全和危象的病例。对于接受依托咪酯诱导全身麻醉后出现低血压且对标准血管加压药治疗无效的重症监护病房患者，应怀疑存在急性肾上腺功能不全。
