Acute adrenal insufficiency following arthroplasty: a case report and review of the literature.

BACKGROUND: Acute adrenal insufficiency is a potentially lethal condition rarely caused by bilateral adrenal haemorrhage due to heparin use. Most of the times, it is difficult to establish the diagnosis, as symptoms are not specific. Few cases have been reported in the literature. CASE PRESENTATION: A 52-year-old Caucasian woman presented with abdominal pain, vomiting and weakness nine days after arthroplasty and heparin use. Hyperkalemia, low cortisol and high adrenocorticotropic hormone levels were found, indicating adrenal insufficiency. Magnetic resonance imaging of the upper abdomen was compatible with preceding adrenal haemorrhage. Hydrocortisone and fludrocortisone were administered. Review of the literature revealed 36 cases of postoperative adrenal haemorrhage which are presented briefly. CONCLUSION: Postoperative acute adrenal insufficiency due to haemorrhage is a rare condition. If patients are treated based on clinical suspicion, they have good chances to survive. Hydrocortisone is given permanently in the majority of the patients.

Recurrent glabellar mucous cyst: a rare postrhinoplasty complication.

INTRODUCTION: The appearance of postrhinoplasty mucous cysts is a very rare complication, affecting mostly the nasal dorsum, along with the lines of a nasal osteotomy. There have been also descriptions of other rare locations like the nasal tip, the medial canthus, and the paranasal area. CASE: We present for the first time the appearance of a recurrent mucous cyst in the glabellar area, away from any intervention field during a rhinoplasty. Ectopic free mucosal graft implantation during surgical treatment, herniation of mucosa through intranasal incisions, or improper clearing of mucous epithelial remnants and bony or cartilage parts during the operation are the most accepted theories for the formation of mucous cysts after rhinoplasty. Until now, there have been published 19 cases of postrhinoplasty mucous cysts, with the nasal dorsum being the most affected side. The glabella, as a site away from any line of osteotomy in an usually performed rhinoplasty, has never been before reported as a region of mucous cyst formation. CONCLUSION: The patient is still under periodical control, and 68 months postoperatively, there is no evidence of a recurrence.