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Case Reports
. 2025 Jul 29;17(7):e88971.
doi: 10.7759/cureus.88971. eCollection 2025 Jul.

Adrenal Crisis: From Perioperative Clinic to Diagnosis

Ahmet Gültekin  1 , Kağan Berkay Öner  1 , İlker Yıldırım  1 , Cavidan Arar  1 , Selami Gürkan  2
Affiliations
Case Reports

Adrenal Crisis: From Perioperative Clinic to Diagnosis

Ahmet Gültekin et al. Cureus. .

Abstract

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.

Keywords: adrenal crisis; adrenal insufficiency (ai); high-dose vasopressors; perioperative hypotension; persistent electrolyte imbalances.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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