Fatal outcome during anaesthesia induction in a patient with amiodarone-induced thyrotoxicosis.

which was significantly different (P, 0.01, Wilcoxon rank sum test) from the treatment group. Cancer (22 patients), primary sepsis (15 patients), multiple trauma (11 patients), intracranial bleeding (11 patients), subarachnoid haemorrhage (11 patients) and aortic aneurysm rupture/repair (11 patients) were among the more common admission diagnosis in patients with adrenal and relative adrenal insufficiency. Patients with a history of hypertension, coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease and/or vascular disease seem to be at higher risk for these conditions although our study size was too small for logistic regression analysis. Etomidate use for intubation could be identified in only one patient. Overall, our findings support the notion that adrenal insufficiency diagnosed with a 1-mg cosyntropin test is common in surgical patients with volume refractory shock and responsive to hydrocortisone substitution independent of confirmed sepsis. Larger scale epidemiologic and prospective studies are warranted to determine whether patients should be routinely tested with low-dose or high-dose cosyntropin tests or empirically treated with hydrocortisone and classified as clinical responders or non-responders after 24 h.