Dexamethasone is widely used in current practice for the prevention of postoperative nausea and vomiting. Although its use in the perioperative setting has been associated with several side effects (eg, hyperglycemia and suppression of adrenal cortisol production), their clinical significance remains questionable. We present the case of a healthy 27-year-old woman who developed acute adrenal insufficiency after receiving intraoperative dexamethasone for postoperative nausea and vomiting prophylaxis during a laparoscopic left oophorectomy.