Objective:

To report a case of postoperative adrenal crisis-like deterioration following adrenalectomy for a non-functioning adrenal tumor and evaluate the role of perioperative dexamethasone.

Approach:

• Case Report: A 33-year-old woman underwent right adrenalectomy for a non-functioning adrenal tumor and received dexamethasone for antiemetic prophylaxis.

Key Findings:

• The patient developed symptoms consistent with adrenal crisis, including hypotension and altered mental status, 54 hours post-surgery.
• Endocrine testing showed marked suppression of ACTH and cortisol levels, indicating potential glucocorticoid effects.
• Differential diagnosis for postoperative complications included infection, thromboembolic disease, and metabolic disturbances.

Interpretation:

Perioperative dexamethasone may be associated with postoperative endocrine disturbances that mimic adrenal crisis; however, causality cannot be definitively established.

Limitations:

• Preoperative endocrine evaluation did not include a 1 mg overnight dexamethasone suppression test, which is critical for assessing cortisol excess.
• Dynamic assessment of adrenal reserve was not performed preoperatively, limiting the evaluation of adrenal function.

Conclusion:

Careful differential diagnosis is essential in the postoperative setting following adrenal surgery.