<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2182-5173</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Medicina Geral e Familiar]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Med Geral Fam]]></abbrev-journal-title>
<issn>2182-5173</issn>
<publisher>
<publisher-name><![CDATA[Associação Portuguesa de Medicina Geral e Familiar]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2182-51732025000400354</article-id>
<article-id pub-id-type="doi">10.32385/rpmgf.v41i4.13916</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Insuficiência adrenal após stress cirúrgico: relato de caso]]></article-title>
<article-title xml:lang="en"><![CDATA[Adrenal insufficiency due to post-surgical stress: case report]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Reis]]></surname>
<given-names><![CDATA[Ana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Nogueira]]></surname>
<given-names><![CDATA[Joana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ULS Matosinhos USF Porta do Sol ]]></institution>
<addr-line><![CDATA[Leça do Balio ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2025</year>
</pub-date>
<volume>41</volume>
<numero>4</numero>
<fpage>354</fpage>
<lpage>358</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2182-51732025000400354&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2182-51732025000400354&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2182-51732025000400354&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  Insuficiência adrenal consiste numa condição clínica que pode dever-se a múltiplas patologias que afetam a síntese e/ou secreção de cortisol pela glândula suprarrenal. A apresentação clínica pode variar desde uma crise adrenal (insuficiência adrenal aguda) a uma instalação gradual de sintomas inespecíficos (insuficiência adrenal crónica). Neste artigo descreve-se o caso de uma doente que desenvolveu sintomas de insuficiência adrenal crónica após cirurgia de correção de hemorroidas, alertando para a inespecificidade dos sintomas desenvolvidos e sua evolução, e realçando a necessidade de suspeitar e excluir a existência desta patologia perante sintomas similares.  Descrição do caso:  Mulher de 68 anos, autónoma para as atividades de vida diárias, com antecedentes de hiperplasia adrenal congénita (por bloqueio da enzima 21-hidroxilase) de diagnóstico aos 10 anos de idade, estando medicada com dexametasona. Após realizar cirurgia de correção de hemorroidas apresenta queixas, de novo, de astenia marcada e desequilíbrio da marcha com agravamento progressivo, anorexia e perda ponderal. Realizou estudo analítico, que revelou aumento da hormona adrenocorticotrófica, cortisol sérico matinal diminuído e diminuição de sulfato de deidroepiandrosterona (DHEAs). Perante a suspeita de insuficiência adrenal, a doente é enviada à consulta externa de endocrinologia no hospital de referência, onde se objetiva que não terá sido realizado aumento da dose de corticoide oral face ao stress da realização de cirurgia com anestesia geral. Adicionalmente, quando questionada ativamente, a doente refere ter suspendido espontaneamente a toma de dexametasona após o início dos sintomas.  Comentário:  A insuficiência adrenal crónica pode ser difícil de diagnosticar e o seu diagnóstico perdido pelos sintomas inespecíficos. Este caso procura alertar para a importância de incluir esta patologia na lista de diagnósticos diferenciais perante um quadro como o descrito.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Adrenal insufficiency is a clinical condition that may be due to multiple pathologies that affect the adrenal glands&#8217; synthesis and/or secretion of cortisol. The clinical presentation can vary from an adrenal crisis (acute adrenal insufficiency) to a gradual onset of non-specific symptoms (chronic adrenal insufficiency). In this article, we describe the case of a patient who developed symptoms of chronic adrenal insufficiency after hemorrhoidectomy, highlighting the nonspecificity of the symptoms developed and their evolution, and the need to suspect the existence of this pathology when faced with similar symptoms.  Case description:  68-year-old woman, independent in her daily activities, with a history of congenital adrenal hyperplasia (due to blockage of the 21-hydroxylase enzyme) diagnosed at the age of 10, which is being treated with dexamethasone. After undergoing hemorrhoidectomy, she complained of progressively worsening asthenia and gait imbalance, anorexia, and weight loss. She conducted an analytical study that revealed an increase in adrenocorticotropic hormone, a decrease in morning serum cortisol, and a decrease in dehydroepiandrosterone sulphate (DHEAs). Given the suspicion of adrenal insufficiency, the patient is sent to an Endocrinology consultation at the reference hospital, where it is found that the dose of oral corticosteroids was not increased after the stress of undergoing surgery with general anesthesia. Additionally, when actively questioned, the patient stated that she had spontaneously stopped taking dexamethasone after the symptoms began.  Comment:  Chronic adrenal insufficiency can be difficult to diagnose, and its diagnosis lost due to the nonspecific symptoms. This case seeks to reinforce the importance of including this pathology in the list of differential diagnoses when faced with a condition such as the one described.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Insuficiência adrenal]]></kwd>
<kwd lng="pt"><![CDATA[Hemorroidectomia]]></kwd>
<kwd lng="pt"><![CDATA[Relato de caso]]></kwd>
<kwd lng="en"><![CDATA[Adrenal insufficiency]]></kwd>
<kwd lng="en"><![CDATA[Hemorrhoidectomy]]></kwd>
<kwd lng="en"><![CDATA[Case report]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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