Korean J Anesthesiol.  2004 Oct;47(4):603-607. 10.4097/kjae.2004.47.4.603.

Functional Adrenal Insufficiency in a Patient with Huge Intra-Hepatic Cyst during Induction of Anesthesia: A case report

• Shin SH
• Kang JG
• Sim WS
• Kim GS
• Lee SM

• KMID: 2299304
• DOI: http://doi.org/10.4097/kjae.2004.47.4.603

Abstract

An obese, 65 years old woman admitted to the department of orthopedics for total knee replacement arthroplasty under the diagnosis of severe degenerative arthritis and pain of both knee joints. Incidentally, an asymptomatic huge hepatic cyst (size 25 x 27 cm) was found in the pre-operative check ups During the induction of general anesthesia, severe hypotension and intractable atrial fibrillation with RVR suddenly developed. Initially, various tilting positions together with rapid fluid replacement were tried immediately considering the clinical features as supine hypotensive episode, but with little improvement of clinical situation. Then, a bolus of intravenous hydrocortisone succinate 100 mg was tried empirically, resulting in the immediate normalization of blood pressure. Her laboratory findings after the incidence showed decreased blood cortisol level, but ACTH stimulation test was within normal limits. We concluded the case, clinically, as functional adrenal insufficiency and report the case with the reviews of related articles

Keyword

adrenal insufficiency; hepatic cyst

MeSH Terms

Adrenal Insufficiency*
Adrenocorticotropic Hormone
Aged
Anesthesia*
Anesthesia, General
Arthroplasty
Arthroplasty, Replacement, Knee
Atrial Fibrillation
Blood Pressure
Diagnosis
Female
Humans
Hydrocortisone
Hypotension
Incidence
Knee Joint
Orthopedics
Osteoarthritis
Succinic Acid
Adrenocorticotropic Hormone
Hydrocortisone
Succinic Acid