Anesthetic Management of Emergent Laparoscopic Bilateral Adrenalectomy in a Patient with a Life-Threatening Cortisol Crisis

Abstract

Cushing syndrome may rarely present with life-threatening hypercortisolism, manifested by hypertension, hypokalemia, hyperglycemia, and edema. If medical treatment proves ineffective in ameliorating the symptoms, emergent rescue adrenalectomy may be the only way to relieve the crisis. We describe the anesthetic management of a patient with an ectopic adrenocorticotropic hormone-secreting tumor, whose condition was rapidly deteriorating due to severe cortisol excess, and emergent adrenalectomy was the only available therapeutic modality. Despite severe metabolic derangement, edema, and incipient respiratory failure, emergent bilateral laparoscopic adrenalectomy was performed and the patient improved sufficiently to undergo surgery for the ectopic lesion without incident.

Maximum tolerant dose and analgesic activity of PT1 peptide

“…It was established that the pain arising in case of tissue damage has a phase character: first, it is acute and well localized, and then after a few seconds, it is replaced by diffuse, less acute and more emotionally colored. Such dynamics of pain is associated with the participation of various afferent systems in conducting nociceptive impulses (Al Darwish Alopecosa marikovskyi et al 2016, Dyachenko et al 2018, Palikova et al 2018a, Palikova et al 2018b, Sharkey 2013, Sharma et al 2015.…”

Anaesthetic Challenges for Laparoscopic Bilateral Adrenalectomy in a Rare Case of Cushing’s Syndrome – A Case Report

“…Treatment of Cushing syndrome was towards normalizing cortisol levels and its various systemic effects. Inadequate treatment of Cushing's syndrome may result in cortisol storm or crisis, a life threatening complication [3].…”