1. 2006;9;257-260Vertebral Augmentation Complicated by Perioperative Addisonian Crisis
   A Case Report
   Alexander J Nemeth, MD, Theresa J Lie-Nemeth, MD, John J. A Marota, MD, PhD, Johnny C Pryor, MD, James D Rabinov, MD, and Joshua A Hirsch, MD.

Background: We describe a case of perioperative Addisonian crisis induced by vertebral augmentation. While several complications of vertebral augmentation have been reported previously, related to the technical procedure, to our knowledge, perioperative Addisonian crisis from vertebral augmentation has not been reported in the literature.

Objective: To report an Addisonian crisis perioperative to vertebral augmentation.

Design: Case report.

Method: Retrospective case review.

Results: The patient had a history of adrenal insufficiency treated previously with steroids. He developed an L3 vertebral compression fracture, failed conservative therapy and was eventually referred for vertebral augmentation. Immediately after starting the procedure, the patient developed profound hypotension unresponsive to intravenous fluids and vasopressors, consistent with Addisonian crisis. After intravenous steroids had resolved the Addisonian crisis, he underwent vertebral augmentation without further complication.

Conclusion: Addisonian crisis may be triggered by vertebral augmentation. Practitioners need to recognize immediately this potentially lethal disorder in patients with known or suspected adrenal

 insufficiency and treat with intravenous hydrocortisone.