FATAL ADRENAL CORTICAL INSUFFICIENCY PRECIPITATED BY SURGERY DURING PROLONGED CONTINUOUS CORTISONE TREATMENT

Abstract

Sudden withdrawal of cortisone from patients on long term therapy, even for a very brief period of time, may produce severe adrenal cortical insufficiency following surgical operation or similar stressful experiences. A fatal result of capsulotomy and tendon lengthening for contracture of the right knee under Na pentothal and inhalation nitrous oxide anesthesia is descr. The patient had recieved cortisone, 50 mg. daily, for several months until the day of operation. Postoperatively there was shock, cyanosis, and hyperpyrexia. Death ensued after 5.75 hrs. despite blood transfusion, electrolyte control and other supportive measures. Neither cortisone nor ACTH was administered postoperatively. Autopsy revealed pronounced bilateral atrophy of adrenal cortex and medulla with extreme hyperemia and some hemorrhage. Death was considered to be due to acute adrenal insufficiency.