Case report: Suspected adrenal crisis after non-functional adrenal tumor resection: a case of temporal association with perioperative dexamethasone.

Perioperative dexamethasone is commonly used in enhanced recovery protocols, yet its safety in adrenalectomy remains underevaluated. We report a 33-year-old woman who developed postoperative adrenal crisis-like deterioration 54 hours after right adrenalectomy for a radiologically and biochemically non-functioning adrenal tumor on basal preoperative testing. A single 5 mg intravenous dose of dexamethasone was administered intraoperatively for antiemetic prophylaxis. During clinical deterioration, the patient exhibited marked suppression of ACTH and cortisol, consistent with pharmacological glucocorticoid effects in the perioperative period. However, the clinical presentation was non-specific and alternative postoperative complications, including infection, thromboembolic disease, and metabolic disturbances, could not be fully excluded. The patient improved following combined supportive therapy and stress-dose hydrocortisone. Preoperative endocrine evaluation did not include a 1 mg overnight dexamethasone suppression test, and mild autonomous cortisol secretion could not be excluded. Dynamic assessment of adrenal reserve was not performed preoperatively. This case highlights that perioperative dexamethasone may be temporally associated with postoperative endocrine perturbations that mimic adrenal crisis in susceptible patients. However, causality cannot be established, and careful differential diagnosis is essential in the postoperative setting following adrenal surgery.