An ACTH stimulation test (250 mcg) was abnormal with baseline value of 2.7 mcg/dL and 60-minute value of 17 mcg/dL. She was re-evaluated at our center and found to have 20 lb weight loss and orthostatic hypotension (BP 103/71 mmHg lying, 94/62 mmHg sitting and 84/60 mmHg standing). Extensive testing at outside hospital with CT scan of head, Holter monitor and 2-D echo did not reveal an etiology. She continued to have nausea, vomiting, weight loss, and syncope. She received IV fluids and was discharged home. Non-contrast abdominal CT revealed post-op changes in the renal fossa, no fluid collection and normal adrenal glands. She eventually tolerated oral intake and was discharged on post-op day 5 but readmitted on post-op day 12 for recurrent nausea, dehydration, hypotension (BP 70/60 mmHg). Post-operatively she had persistent nausea and vomiting. All other testing including UA, urine protein, blood work, CXR, EKG were normal and blood pressure was 102/55 mmHg with HR of 74/min. Pre-operatively, her creatinine was 0.8 mg/dL with estimated GFR of 100.6 mL/min. She had no medical history and had an active lifestyle. We present a case of adrenal insufficiency after laparoscopic left donor nephrectomy.Ī 28 year old Caucasian woman was evaluated as a kidney donor. Although rare, donor nephrectomy is associated with post-surgical problems. Safety of living donors is paramount to the transplant community.
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