A patient undergoes bilateral adrenalectomy in view of bilateral pheochromocytoma. A day after surgery patient develops lethargy, fatigue and loss of appetite. On examination BP is 90/ 60 mmHg, pulse rate of 74 beats/min. No evidence of loss of volume. The likely cause is?
**Core Concept**
Adrenalectomy, especially bilateral, can lead to adrenal insufficiency due to the loss of cortisol production. This is because the adrenal glands produce cortisol, a vital hormone essential for maintaining blood pressure, glucose metabolism, and the body's response to stress.
**Why the Correct Answer is Right**
The patient's symptoms of lethargy, fatigue, and loss of appetite, along with hypotension (low blood pressure) and a normal pulse rate, suggest adrenal insufficiency. This is because cortisol helps regulate blood pressure and the body's response to stress. In the absence of cortisol, the body cannot effectively respond to stress, leading to the observed symptoms. Additionally, the lack of evidence of volume loss suggests that the hypotension is not due to fluid loss, but rather due to a deficiency in cortisol production.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is not directly relevant to the scenario described. There is no indication of an electrolyte imbalance, and the symptoms do not suggest a condition related to electrolyte disturbances.
**Option B:** While hypotension can be a symptom of anaphylaxis, the patient's normal pulse rate and lack of other systemic symptoms (such as rash, wheezing, or bronchospasm) make anaphylaxis an unlikely diagnosis.
**Option C:** This option is not relevant to the scenario described. There is no indication of a cardiac issue, and the patient's symptoms do not suggest a condition related to cardiac dysfunction.
**Clinical Pearl / High-Yield Fact**
In patients undergoing bilateral adrenalectomy, it is crucial to monitor for signs of adrenal insufficiency, including hypotension, lethargy, and fatigue. Cortisol replacement therapy may be necessary to prevent adrenal crisis.
**Correct Answer:** D. Adrenal insufficiency.