Title:Reversibility of Acute Adrenal Insufficiency After Hip Replacement: A Case Series
Volume: 21
Issue: 9
Author(s): Adele Latina*, Micaela Pellegrino, Alfonsina Chiefari, Pina Lardo, Anna Pia, Giuseppe Reimondo and Giorgio Borretta
Affiliation:
- Division of Endocrinology, Diabetology and Metabolism, Santa Croce and Carle Hospital, Via A. Carle n. 5, 12100 Cuneo,Italy
Keywords:
Adrenal insufficiency, surgery, adrenal cortex diseases, acetate, cortisol basal, orthopedic.
Abstract:
Background: Acute adrenal insufficiency is a rare but potentially lethal condition, that
is important to identify promptly and treat with replacement therapy. It can be consequent to adrenal
hemorrhage that can occur after major orthopedic surgery. Few data are available about potential
recovery of adrenal function, as well as both timing and modality of cortisone acetate withdrawal,
probably due to the assumption that adrenal failure should be definitive. The extension of adrenal
damage can be different, so justifying a partial, or potentially complete, recovery of adrenal
function. The aim of our article is to highlight the opportunity of a periodical revaluation of adrenal
reserve in order to identify those patients which are able to interrupt replacement therapy.
Case Presentation: We had recently described one case of acute adrenal insufficiency, which developed
short time after hip replacement; the patient was able to discontinue cortisone acetate treatment
46 months after the diagnosis and remained untreated up to five years later. We collected
other two cases of acute adrenal insufficiency, developed about one week after major orthopedic
surgery. We followed such patients for about three years, repeatedly reassessing adrenal imaging
and cortisol response to 250 μg ACTH test, in order to ascertain the real need of lifetime substitutive
treatment with cortisone acetate. Acute adrenal insufficiency partially reverted during the follow
up for both patients. We observed a reduction in adrenal glands’ volume and a progressive improvement
of cortisol basal levels, without response (or with a poor one) to ACTH stimulation, as
well as with ACTH basal levels persistently above the normal range after 36 and 28 months respectively
spent from the acute event.
Conclusion: The present finding suggests the opportunity that patients developing acute adrenal insufficiency
after major orthopedic surgery undergo long-term surveillance, in order to establish if
steroid replacement has to be continued, or it can be safely withdrawn.
