Gültekin Ahmet, Öner Kağan Berkay, Yıldırım İlker, Arar Cavidan, Gürkan Selami
Department of Anesthesiology and Reanimation, Tekirdağ Namık Kemal University Faculty of Medicine, Tekirdağ, TUR.
Department of Cardiovascular Surgery, Tekirdağ Namık Kemal University Faculty of Medicine, Tekirdağ, TUR.
Cureus. 2025 Jul 29;17(7):e88971. doi: 10.7759/cureus.88971. eCollection 2025 Jul.
Adrenal crisis, a life-threatening complication of adrenal insufficiency, can present perioperatively with refractory hypotension and electrolyte imbalances. This case report describes a 77-year-old woman with multiple comorbidities who developed intraoperative shock unresponsive to high-dose vasopressors during aortobifemoral bypass surgery. Persistent hypokalemia and hypoglycemia raised suspicion of adrenal insufficiency, prompting empiric intravenous (IV) methylprednisolone (75 mg), which rapidly resolved hypotension and obviated further inotropic support. The case underscores the importance of considering adrenal crisis in perioperative refractory hypotension, even without prior diagnosis. Early glucocorticoid administration, prior to confirmatory laboratory results, is critical to prevent mortality.
肾上腺危象是肾上腺功能不全的一种危及生命的并发症，可在围手术期出现难治性低血压和电解质失衡。本病例报告描述了一名患有多种合并症的77岁女性，在主动脉双股动脉搭桥手术期间发生术中休克，对高剂量血管升压药无反应。持续性低钾血症和低血糖症引发了对肾上腺功能不全的怀疑，促使经验性静脉注射甲泼尼龙（75毫克），这迅速缓解了低血压并避免了进一步的强心支持。该病例强调了即使没有先前诊断，在围手术期难治性低血压中考虑肾上腺危象的重要性。在实验室确诊结果出来之前尽早给予糖皮质激素对于预防死亡至关重要。
