ABSTRACT

Objective: Addison’s crisis (adrenal crisis) – Schmidt syndrome. To show the course, diagnostic methods and treatment of acute hypocorticism in the patient operated with the symptoms of acute abdomen.

Design: Case report.

Setting: Department of Obstetrics and Gynecology FN UP Olomouc.

Case report: Patient J. M., 28 years old, treated for primary infertility. Within the ultrasound investigation the solitary myoma in diameter of 7 cm was revealed which deformed the uterine cavity. Patient was admitted to the hospital before the scheduled operation because of the lower abdominal pain, headache, fever and weakness. She got worse and after the surgeon consultation the acute laparotomy was performed with no pathology finding in the abdominal cavity. Planned myomectomy was added. During the postoperative course the onset of hypoglycaemic convulsion occurred with the loss of the consciousness. 24 hours after the operation another deterioration occurred with the fever and somnolence. Intraabdominal bleeding was suspected. Relaparotomy was performed with no pathology finding again. Consequently the diagnosis of acute peripheral hypocorticism was set by endocrinologist. After the hydrocortisone substitution the patient rapidly improved.

Conclusion: Acute Addison disease can imitate the symptoms of acute abdomen. The endocrinologist’s co-operation is needful.

Key words: acute adrenal insufficiency, adrenal crisis, Schmidt syndrome, Addison, operation