Refractory Hypotension in a Patient with a History of Anabolic Steroid Abuse Taking an Angiotensin-II Receptor Blocker: A Case Report

The renin-angiotensin-aldosterone system (RAAS) is a key component of blood pressure regulation. Patients who take RAAS antagonists on the morning of surgery are at risk of developing hypotension under anesthesia that is refractory to treatment with fluid boluses and conventional vasopressors. This case report describes a unique case of refractory hypotension in a patient with a history of anabolic steroid abuse taking an angiotensin II receptor blocker. An understanding of the role of the RAAS in blood pressure regulation is essential for managing refractory hypotension in the patient under general anesthesia. A scarcity of data on the anesthetic implications of anabolic steroid abuse exists, but an understanding of the physiologic implications of anabolic steroid abuse can help guide management for these patients.