Acute Adrenal Insufficiency—Withholding of Medicines in the Peri‐Operative Period

Background Patients with adrenal insufficiency cannot respond to stress by increasing secretion of endogenous cortisol and need supplemental steroid to avoid an acute adrenal crisis. Aim To describe a case of acute adrenal insufficiency due to withholding of oral cortisone during the peri‐operative period. Clinical features A 68‐year‐old male deteriorated during his hospital admission for septic arthritis. He was known to have panhypopituitarism following the resection of a pituitary adenoma. During admission, his regular doses of oral cortisone were withheld due to a pre‐operative nil‐by ‐mouth order. He became symptomatic of glucocorticoid deficiency and was subsequently treated with IV hydrocortisone. Outcome The patient recovered after receiving glucocorticoid replacement therapy. Conclusion Pharmacists should ensure accurate drug histories are taken and provide guidance on medication management through the development of multidisciplinary pre‐operative guidelines.