[When is a perioperative glucocorticoid stress-dose regime indicated?]

To avoid a life-threatening crisis due to adrenal insufficiency during or after surgery, extra glucocorticoids are often administered perioperatively to patients already taking them. However, this type of supplementation also has a downside, e.g. complications such as fluid retention, hyperglycaemia, psychiatric disturbances, infection and delayed wound healing. In patients with primary or central adrenal insufficiency their daily hydrocortisone substitution should be supplemented perioperatively depending on the type of surgery. Also, suppression of the pituitary-adrenal function may occur in patients being treated with exogenous glucocorticoids for other diseases and this may justify perioperative supplemental glucocorticoid administration. However, the extent of adrenal suppression in response to exogenous glucocorticoids is heterogeneous. This can be explained by differences in glucocorticoid type and dosage, treatment duration, mode of administration, as well as an individual's glucocorticoid sensitivity and metabolism of glucocorticoids. In this article we provide suggestions as to which patients should or should not be perioperatively supplemented with glucocorticoids.