Abstract
This case involves a 29-year-old male who had, until 8 years ago, undergone radiation therapy for pituitary germinoma and was taking 20mg hydrocortisone daily for panhypopituitarism. Suffering profuse diarrhea, he was transported to our emergency department with exhaustion and hypothermia. Hypothermia treatment started with electric blankets for surface rewarming and warm gastric lavage for internal rewarming. Hypotension resulted from rewarming and rewarming shock suspected. Fluid loading was performed with no response. Dopamine was started but hypotension continued. Acute adrenal insufficiency was suspected due to the patient's medical history and catecholamine resistant shock, so 100 mg of hydrocortisone was administered intravenously 11 hours after arrival. Blood pressure slowly increased, allowing gradual reduction of fluid loading and dopamine. Before administering the hydrocortisone, serum cortisol concentration was 1.4μg/dl. On the 4th day of hospitalization, the patient was transferred from ICU and on the 11th day received an ambulatory discharge. Acute adrenal insufficiency is well known, but emergency room encounters are rare. Symptoms vary and lab findings are non-specific, making diagnosis difficult. When faced with catecholamine resistant shock, early diagnosis and treatment can influence the prognosis. Based upon the patient's medical history and developments, acute adrenal insufficiency should initially be suspected and steroids administered.
