Vertebral augmentation complicated by perioperative addisonian crisis

Alexander J. Nemeth*, Theresa J. Lie-Nemeth, John J A Marota, Johnny C. Pryor, James D. Rabinov, Joshua A. Hirsch

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background: We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature. Objective: To report an Addisonian crisis perioperative to vertebral augmentation. Design: Case report. Method: Retrospective case review. Results: The patient had a history of adrenal insufficiency treated previously with steroids. He developed an L 3 vertebral compression fracture, failed conservative therapy and was eventually referred for vertebral augmentation. immediately after starting the procedure, the patient developed profound hypotension unresponsive to intravenous fluids and vasopressors, consistent with Addisonian crisis. After intravenous steroids had resolved the Addisonian crisis, he underwent vertebral augmentation without further complication. Conclusion: Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal insufficiency and treat with intravenous hydrocortisone.

Original languageEnglish (US)
Pages (from-to)257-260
Number of pages4
JournalPain physician
Volume9
Issue number3
StatePublished - Jul 1 2006

Keywords

  • Critical care
  • Image-guided procedure
  • Metabolic abnormality
  • Vertebral augmentation
  • Vertebral compression fracture

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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