{"id":"dc952e01-bdc3-46b8-9266-764aa07e51c1","slug":"acute-suppression-of-the-hypothalamo-pituitary-adrenal-axis-from-a-large-singular-dose-of-dexamethasone-a-case-report-on-a-hypothesis-for-resistant-intraoperative-hypotension","title":"Acute suppression of the hypothalamo-pituitary-adrenal axis from a large singular dose of dexamethasone: A case report on a hypothesis for resistant intraoperative hypotension","authors":["Prachi Sharma","Ramesh Venkatapura"],"abstract":"Background: Dexamethasone is commonly used in neurosurgery for preventing postoperative nausea and managing cerebral edema. Its administration can lead to significant suppression of the hypothalamic-pituitary-adrenal (HPA) axis, which is regulated by negative feedback mechanisms. The duration and implications of this suppression following a single high dose remain inadequately understood. Summary: In a case involving a 9-year-old female undergoing craniotomy, resistant hypotension developed after the administration of 8 mg dexamethasone. Despite standard interventions, blood pressure did not stabilize until intravenous hydrocortisone was administered. This suggests a potential link between the high dexamethasone dose and increased cortisol demand due to surgical stress, leading to HPA axis suppression. Conclusion: The findings indicate that acute hypotension can occur in pediatric neurosurgical patients following a single high dose of dexamethasone, emphasizing the need for careful monitoring and potential steroid therapy during surgery. Further investigation into HPA axis suppression in this context is warranted. Keywords: dexamethasone, HPA axis, hypotension, pediatric neurosurgery, steroid therapy, cortisol, surgical stress","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/dc952e01-bdc3-46b8-9266-764aa07e51c1/featured/hero-1781559410999.png","publishDate":"2024-07-05T00:00:00.000Z","doi":"10.25259/SNI_273_2024","categories":["Neuroanesthesia and Critical Care","Letter to the Editor"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2024/07/12979/SNI-15-230.pdf"}