Hydrocortisone-replacement therapy in a patient with relative adrenal insufficiency associated with cardiopulmonary arrest resulting from a ruptured ectopic pregnancy

DOI 15 References
  • Osawa Takeshi
    Department of Surgery, Tannan Regional Medical Center
  • Fukui Michihiko
    Department of Emergency and Critical Care Medicine, Otsu Municipal Hospital
  • Kooguchi Kunihiko
    Department of Emergency and Critical Care Medicine, Otsu Municipal Hospital
  • Inoue Shizuka
    Department of Emergency and Critical Care Medicine, Otsu Municipal Hospital
  • Yamada Tomoki
    Department of Emergency and Critical Care Medicine, Otsu Municipal Hospital

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  • 子宮外妊娠破裂による心肺停止の蘇生後に生じた相対的副腎機能不全に対してヒドロコルチゾン補充療法が有効であった1例

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We report a case of relative adrenal insufficiency associated with cardiopulmonary arrest resulting from a ruptured ectopic pregnancy. A 33-year-old female was transported to our hospital 14 hours after the rupture of an ectopic pregnancy; upon arrival, she immediately experienced cardiopulmonary arrest. Her heart was restarted using cardiopulmonary resuscitation (CPR), and she underwent an urgent operation. Her circulatory dynamics destabilized on the 1st postoperative day. An investigation using a pulmonary artery catheter revealed the cause of the instability to be vasodilatory shock. Hydrocortisone was administered after examination using adrenocorticotropic hormone (ACTH) loading. The initial dose of hydrocortisone was 200 mg·day-1; this dose was gradually tapered over a period of 16 days, and the patient's circulatory dynamics were stabilized. The results of the ACTH load examination suggested relative adrenal insufficiency. Continuous hemodiafiltration (CHDF) and plasma exchange, etc., were used to treat the patient's multiple organ failure, including the coagulation disorder, disseminated intravascular coagulation (DIC), acute liver failure, acute renal failure, and multiple brain hemorrhages. The patient's condition stabilized, and she was moved to a general ward on the 24th postoperative day. No permanent disabilities other than a slight decrease in intelligence were noted. Relative adrenal insufficiency should be considered as a possible cause of acute circulatory dysfunction resulting from extensive internal injury.

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