Addison's Disease Research Today is a free monthly online journal that collates and summarizes the latest research about Addison's Disease, including details on chronic adrenal insufficiency, treatment, causes, medication.

Hydrocortisone improves somnolence without hypotension in the postpartum period.

Usta-Makkaoui N, Lacy TL, Connelly NR

Department of Anesthesiology, Baystate Medical Center, Springfield, MA 01199, USA.

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.

Published 28 February 2008 in J Anesth, 22(1): 49-51.
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