Hydrocortisone improves somnolence without hypotension in the postpartum period
Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hy...
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| Veröffentlicht in: | Journal of anesthesia 2008-02, Vol.22 (1), p.49-51 |
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| container_title | Journal of anesthesia |
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| creator | Usta-Makkaoui, Nada Lacy, Timothy L. Connelly, Neil Roy |
| description | Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery. We report on a patient whose only presenting symptom was mental status changes; this occurred without any significant hemodynamic changes. These mental status changes responded within minutes to a single dose of hydrocortisone. We recommend administering a pharmacological dose of steroid as a maneuver to rule out adrenal insufficiency when faced with a patient with an unexplained altered mental status while other differential diagnoses are considered. |
| doi_str_mv | 10.1007/s00540-007-0564-4 |
| format | Article |
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When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery. We report on a patient whose only presenting symptom was mental status changes; this occurred without any significant hemodynamic changes. These mental status changes responded within minutes to a single dose of hydrocortisone. We recommend administering a pharmacological dose of steroid as a maneuver to rule out adrenal insufficiency when faced with a patient with an unexplained altered mental status while other differential diagnoses are considered.</description><identifier>ISSN: 0913-8668</identifier><identifier>EISSN: 1438-8359</identifier><identifier>DOI: 10.1007/s00540-007-0564-4</identifier><identifier>PMID: 18306013</identifier><language>eng</language><publisher>Japan: Springer Japan</publisher><subject>Adrenal Insufficiency - diagnosis ; Adrenal Insufficiency - drug therapy ; Adrenal Insufficiency - etiology ; Adult ; Anesthesiology ; Clinical Reports ; Critical Care Medicine ; Diagnosis, Differential ; Disorders of Excessive Somnolence - drug therapy ; Disorders of Excessive Somnolence - etiology ; Emergency Medicine ; Female ; Humans ; Hydrocortisone - therapeutic use ; Hypotension ; Intensive ; Medicine ; Medicine & Public Health ; Pain Medicine ; Postpartum Period ; Pregnancy ; Pregnancy Complications - drug therapy ; Pregnancy Complications - etiology ; Treatment Outcome</subject><ispartof>Journal of anesthesia, 2008-02, Vol.22 (1), p.49-51</ispartof><rights>Japanese Society of Anesthesiologists 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c347t-bf37693ee674c07a5552abf4d972e964901b559260fb8b3f3de2ba5d190c76e43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00540-007-0564-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00540-007-0564-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18306013$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Usta-Makkaoui, Nada</creatorcontrib><creatorcontrib>Lacy, Timothy L.</creatorcontrib><creatorcontrib>Connelly, Neil Roy</creatorcontrib><title>Hydrocortisone improves somnolence without hypotension in the postpartum period</title><title>Journal of anesthesia</title><addtitle>J Anesth</addtitle><addtitle>J Anesth</addtitle><description>Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery. We report on a patient whose only presenting symptom was mental status changes; this occurred without any significant hemodynamic changes. These mental status changes responded within minutes to a single dose of hydrocortisone. We recommend administering a pharmacological dose of steroid as a maneuver to rule out adrenal insufficiency when faced with a patient with an unexplained altered mental status while other differential diagnoses are considered.</description><subject>Adrenal Insufficiency - diagnosis</subject><subject>Adrenal Insufficiency - drug therapy</subject><subject>Adrenal Insufficiency - etiology</subject><subject>Adult</subject><subject>Anesthesiology</subject><subject>Clinical Reports</subject><subject>Critical Care Medicine</subject><subject>Diagnosis, Differential</subject><subject>Disorders of Excessive Somnolence - drug therapy</subject><subject>Disorders of Excessive Somnolence - etiology</subject><subject>Emergency Medicine</subject><subject>Female</subject><subject>Humans</subject><subject>Hydrocortisone - therapeutic use</subject><subject>Hypotension</subject><subject>Intensive</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Pain Medicine</subject><subject>Postpartum Period</subject><subject>Pregnancy</subject><subject>Pregnancy Complications - drug therapy</subject><subject>Pregnancy Complications - etiology</subject><subject>Treatment Outcome</subject><issn>0913-8668</issn><issn>1438-8359</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1Lw0AQhhdRbK3-AC-Sk7fobPYrOUpRKxR60fOSj4lNSXbj7kbpvzchBW-eZmCeeZh5Cbml8EAB1KMHEBzisY1BSB7zM7KknKVxykR2TpaQURanUqYLcuX9AQAkpeySLGjKQAJlS7LbHCtnS-tC463BqOl6Z7_RR952xrZoSox-mrC3Q4j2x94GNL6xJmpMFPYY9daHPndh6KIeXWOra3JR563Hm1NdkY-X5_f1Jt7uXt_WT9u4ZFyFuKiZkhlDlIqXoHIhRJIXNa8ylWAmeQa0ECJLJNRFWrCaVZgUuahoBqWSyNmK3M_e8dyvAX3QXeNLbNvcoB28VsA4KAojSGewdNZ7h7XuXdPl7qgp6ClFPaeop3ZKUU_yu5N8KDqs_jZOsY1AMgN-HJlPdPpgB2fGh_-x_gJCHn59</recordid><startdate>20080201</startdate><enddate>20080201</enddate><creator>Usta-Makkaoui, Nada</creator><creator>Lacy, Timothy L.</creator><creator>Connelly, Neil Roy</creator><general>Springer Japan</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20080201</creationdate><title>Hydrocortisone improves somnolence without hypotension in the postpartum period</title><author>Usta-Makkaoui, Nada ; Lacy, Timothy L. ; Connelly, Neil Roy</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c347t-bf37693ee674c07a5552abf4d972e964901b559260fb8b3f3de2ba5d190c76e43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Adrenal Insufficiency - diagnosis</topic><topic>Adrenal Insufficiency - drug therapy</topic><topic>Adrenal Insufficiency - etiology</topic><topic>Adult</topic><topic>Anesthesiology</topic><topic>Clinical Reports</topic><topic>Critical Care Medicine</topic><topic>Diagnosis, Differential</topic><topic>Disorders of Excessive Somnolence - drug therapy</topic><topic>Disorders of Excessive Somnolence - etiology</topic><topic>Emergency Medicine</topic><topic>Female</topic><topic>Humans</topic><topic>Hydrocortisone - therapeutic use</topic><topic>Hypotension</topic><topic>Intensive</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Pain Medicine</topic><topic>Postpartum Period</topic><topic>Pregnancy</topic><topic>Pregnancy Complications - drug therapy</topic><topic>Pregnancy Complications - etiology</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Usta-Makkaoui, Nada</creatorcontrib><creatorcontrib>Lacy, Timothy L.</creatorcontrib><creatorcontrib>Connelly, Neil Roy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Usta-Makkaoui, Nada</au><au>Lacy, Timothy L.</au><au>Connelly, Neil Roy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hydrocortisone improves somnolence without hypotension in the postpartum period</atitle><jtitle>Journal of anesthesia</jtitle><stitle>J Anesth</stitle><addtitle>J Anesth</addtitle><date>2008-02-01</date><risdate>2008</risdate><volume>22</volume><issue>1</issue><spage>49</spage><epage>51</epage><pages>49-51</pages><issn>0913-8668</issn><eissn>1438-8359</eissn><abstract>Hypothalamic-pituitary-adrenal (HPA) axis abnormality and adrenal insufficiency secondary to chronic steroid treatment can be present in the perioperative period. When this occurs in pregnant patients during the peripartum period, the usually expected physiological changes may not be present. The hypotension associated with adrenal insufficiency may be masked by the normal physiological changes of pregnancy and delivery. We report on a patient whose only presenting symptom was mental status changes; this occurred without any significant hemodynamic changes. These mental status changes responded within minutes to a single dose of hydrocortisone. We recommend administering a pharmacological dose of steroid as a maneuver to rule out adrenal insufficiency when faced with a patient with an unexplained altered mental status while other differential diagnoses are considered.</abstract><cop>Japan</cop><pub>Springer Japan</pub><pmid>18306013</pmid><doi>10.1007/s00540-007-0564-4</doi><tpages>3</tpages></addata></record> |
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| subjects | Adrenal Insufficiency - diagnosis Adrenal Insufficiency - drug therapy Adrenal Insufficiency - etiology Adult Anesthesiology Clinical Reports Critical Care Medicine Diagnosis, Differential Disorders of Excessive Somnolence - drug therapy Disorders of Excessive Somnolence - etiology Emergency Medicine Female Humans Hydrocortisone - therapeutic use Hypotension Intensive Medicine Medicine & Public Health Pain Medicine Postpartum Period Pregnancy Pregnancy Complications - drug therapy Pregnancy Complications - etiology Treatment Outcome |
| title | Hydrocortisone improves somnolence without hypotension in the postpartum period |
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