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Anesth Analg 2004;99:1813-1814
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000138058.08094.A4

NEUROSURGICAL ANESTHESIA

Acute Adrenal Insufficiency After Large-Dose Glucocorticoids for Spinal Cord Injury

Harish S. Lecamwasam, MD, Hemanth A. Baboolal, MD, and Peter F. Dunn, MD

Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts

Address correspondence and reprint requests to Peter F. Dunn, MD, Department of Anesthesia and Critical Care, GRB 04-424, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114. Address e-mail to pdunn{at}partners.org

A 24- to 48-h course of large-dose glucocorticoid therapy is often used in the acute management of spinal cord injury. We describe a patient who developed adrenal insufficiency (AI) after this protocol. Although a definitive causal relationship between the steroids and AI was not established, their temporal association and the exclusion of other possible etiologies led us to postulate that AI was a complication of the steroid protocol. Clinicians should, therefore, consider AI in patients with spinal cord injury receiving glucocorticoids, a population in whom it may otherwise go undiagnosed and untreated.

IMPLICATIONS: We describe a patient who developed adrenal insufficiency (AI) after glucocorticoid therapy for spinal cord injury. Their temporal association and the exclusion of other possible etiologies led us to postulate that AI was a complication of the glucocorticoids. Clinicians should, therefore, consider AI in patients with SCI receiving glucocorticoids.






Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.