Before blaming glucocorticoids for prolonged postoperative hypotension, alternative explanations must be carefully ruled out

We read with interest the article by Sharma and Venkatapura on a 9-year-old girl with an extra-axial mass lesion along the vermis who suffered persistent arterial hypotension intraoperatively. [3]e intraoperative hypotension was attributed to suppression of the hypothalamic-pituitary-adrenal (HPA) axis, as only hydrocortisone was effective. [3]It was concluded that resistant perioperative hypotension can occur not only with chronic steroid use but also after a single high dose of steroids and that risk factors for HPA suppression after steroid administration include cumulative duration of use, long-acting agents, and parenteral administration. [3]e study is excellent, but some points should be discussed.