Adrenal insufficiency: report of case

Abstract

SUMMARY The medical consultation from the patient's primary physician, although an invaluable aid in the treatment of the medically compromised patient, is no panacea. The competent management demonstrated by the case report and the potentially life‐threatening situation that followed, can occur with the simple forceps extraction of two periodontally involved teeth.

Risk of adrenal crisis in dental patients

“…Secondary AI was associated with asthma and use of 5 milligrams of prednisolone per day for five years in one patient, 16 with rheumatoid arthritis and use of 5 to 15 mg prednisolone daily for four years in another patient 18 and with acromegaly and lack of pituitary gland function that required daily use of hydrocortisone 25 mg each morning and 12.5 mg each evening for 13 years in a third patient. 19 Preoperative steroid coverage was provided in two cases involving patients with secondary AI. 16,19 Steroid coverage was not provided at the time of the crisis in the two cases involving undiagnosed primary AI.…”

“…19 Preoperative steroid coverage was provided in two cases involving patients with secondary AI. 16,19 Steroid coverage was not provided at the time of the crisis in the two cases involving undiagnosed primary AI. 20,21 In one case of secondary AI, 18 the patient was advised to take additional steroid medication before the dental procedure; however, it is unclear whether he followed these orders.…”

Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature

“…A further case of adrenal crisis was reported by Scheitler et al, 18 involving a 43-year-old man undergoing tooth extraction under local anaesthesia. However this patient, who had well-documented secondary Addison's disease subsequent to pituitary surgery and radiotherapy, had a reaction involving high fever and raised blood pressure inconsistent with acute adrenal insufficiency.…”

Supplemental corticosteroids for dental patients with adrenal insufficiency

“…Our analysis resulted in the identification of only four reports [42][43][44][45] published in peer-reviewed journals that purported that an adrenal crisis related to dental treatment had occurred. This limited number of reported cases (four in 35 years) indicates that this medical emergency is seldom encountered in dentistry.…”

“…trials have been conducted in patients who have AI to definitively establish that corticosteroids are required for dental procedures, guidelines rely on evidence from the above-mentioned studies and the few purported adrenal crisis cases associated with dentistry. [42][43][44][45] From these studies, four factors appear to contribute to the risk of adrenal crisis during the perioperative period of oral surgery. These include the magnitude of surgery, use of general anesthetic, overall health of the patient (for example, stable vs. ongoing infection) and the degree of pain control.…”