engleski

Postoperative adrenal crisis in a patient with Schmidt syndrome (autoimmune polyglandular endocrinopathy Type II)

Schmidt syndrome has been described after recurrent post-partum thyroiditis (6), but we have not find reports of the syndrome in a surgical patient. This case history shows how endocrinological abnormalities which constitute Schmidt syndrome can evolve after surgery: latent adrenal insufficiency into adrenal crisis and thyroid dysfunction (according to the clinical picture - hyperthyroidism) to euthyroid sick syndrome. The particularly severe form of adrenal crisis might be contributed to the fact that cortisol synthesis pathway was blocked at two levels. First, antibodies against 21-hydroxylase which are typical of Schmidt syndrome, inhibited conversion of 17-α -hydroxyprogesterone to 11-deoxycortisol. Second, etomidate inhibits enzyme 11-β -hydroxylase even after a single dose (7) and suppresses conversion of 11-deoxycortisol to cortisol. So, etomidate a useful anaesthetic agent in haemodynamically unstable patients, could have detrimental effect in our patient and contribute for the latent adrenal insufficiency to evolve into the adrenal crisis. A patient with polyglandular endocrinopathy type II confronts anaesthesiologist with two crucial problems: unspecific symptoms which may delay early diagnosis, as was described in several reports, and a possibility of a negative synergism of etomidate and the autoimmune process due to Schmidt syndrome affecting cortisol synthesis.

adrenal crisis; surgery; Schmidt syndrome

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