An 18-year-old male who underwent bilateral adrenalectomy for bilateral pheochromocytoma presents 48 hours after surgery with symptoms of lethargy and fatigue. His blood pressure is 80/60 mmHg, and his pulse rate is 90/min. Clinical examination shows no signs of volume loss.
Given this presentation, what is the most likely diagnosis?
A. Sepsis
B. Cardiogenic shock
C. Addisonian crisis
D. Hypovolemic shock
The Correct Answer: C. Addisonian crisis
Explanation:
– Addisonian Crisis (C): After bilateral adrenalectomy, the patient is at risk of acute adrenal insufficiency (Addisonian crisis) due to the complete loss of adrenal gland function. This condition presents with symptoms of adrenal insufficiency, including hypotension (low blood pressure), lethargy, and fatigue. The lack of volume loss and the acute nature of the symptoms following adrenalectomy support this diagnosis.
Explanation of Other Options:
– Sepsis (A): Although sepsis can cause hypotension and lethargy, the absence of signs of infection and the recent adrenal surgery make sepsis less likely. Sepsis would typically be associated with other signs such as fever, elevated white blood cell count, or other indicators of infection.
– Cardiogenic Shock (B): Cardiogenic shock is caused by the heart’s inability to pump effectively, leading to low blood pressure and potentially other symptoms like shortness of breath or chest pain. It is less likely in this context as the patient does not show signs of heart failure or myocardial dysfunction.
– Hypovolemic Shock (D): This is caused by significant loss of blood volume or fluids, resulting in hypotension. However, the clinical examination shows no signs of volume loss, making hypovolemic shock less likely.
In summary, the most likely diagnosis for this patient, given the recent bilateral adrenalectomy and clinical presentation, is an Addisonian crisis due to acute adrenal insufficiency.