Peritoneal dialysis (PD)-related
peritonitis is one of the most important factors affecting the long-term success of PD.
Adrenal insufficiency is a clinical manifestation of inadequate production of
glucocorticoids with accompanying deficiency of
mineralocorticoids and adrenal
androgens. We present a 58-year-old PD patient who admitted to hospital with
fever,
abdominal pain,
vomiting, and
confusion. The patient was treated with
cephazolin and
ceftazidime after the confirmation of
peritonitis. Despite the resolution of
peritonitis after 2 weeks with appropriate
antibiotic treatment, the patient continued to suffer from
vomiting,
hypotension, and
confusion. After the evaluation of basal serum
cortisol and 250 µg
ACTH stimulation test, the patient had been diagnosed as
adrenal insufficiency and treated with
fludrocortisone 0.1 mg/day. Patients remaining
vomiting,
hypotension, and
confusion symptoms were corrected after the
fludrocortisone therapy. Following 2 months of successful treatment of
adrenal insufficiency, the patient had adherence problem with
fludrocortisone for 3-4 weeks. On an outpatient visit, serum
ACTH and
cortisol levels were normal despite the discontinuation of
fludrocortisone and so the patient had been evaluated as partial
adrenal insufficiency secondary to PD-related
peritonitis. In conclusion,
adrenal insufficiency should be kept in mind in PD patients suffering from
hypotension and
peritonitis.