Adrenal insufficiency due to post-surgical stress: case report
DOI:
https://doi.org/10.32385/rpmgf.v41i4.13916Keywords:
Adrenal insufficiency, Hemorrhoidectomy, Case reportAbstract
Introduction: Adrenal insufficiency is a clinical condition that may be due to multiple pathologies that affect the adrenal glands' synthesis and/or secretion of cortisol. The clinical presentation can vary from an adrenal crisis (acute adrenal insufficiency) to a gradual onset of non-specific symptoms (chronic adrenal insufficiency). In this article, we describe the case of a patient who developed symptoms of chronic adrenal insufficiency after hemorrhoidectomy, highlighting the nonspecificity of the symptoms developed and their evolution, and the need to suspect the existence of this pathology when faced with similar symptoms.
Case description: 68-year-old woman, independent in her daily activities, with a history of congenital adrenal hyperplasia (due to blockage of the 21-hydroxylase enzyme) diagnosed at the age of 10, which is being treated with dexamethasone. After undergoing hemorrhoidectomy, she complained of progressively worsening asthenia and gait imbalance, anorexia, and weight loss. She conducted an analytical study that revealed an increase in adrenocorticotropic hormone, a decrease in morning serum cortisol, and a decrease in dehydroepiandrosterone sulphate (DHEAs). Given the suspicion of adrenal insufficiency, the patient is sent to an Endocrinology consultation at the reference hospital, where it is found that the dose of oral corticosteroids was not increased after the stress of undergoing surgery with general anesthesia. Additionally, when actively questioned, the patient stated that she had spontaneously stopped taking dexamethasone after the symptoms began.
Comment: Chronic adrenal insufficiency can be difficult to diagnose, and its diagnosis lost due to the nonspecific symptoms. This case seeks to reinforce the importance of including this pathology in the list of differential diagnoses when faced with a condition such as the one described.
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