Perioperative management of adrenal cortical suppression

Two questions asked prior to podiatric surgery for patients with a history of steroid therapy are: what are the risks involved with surgery and what specific measures should be taken in perioperative management for these patients? Studies identifying normal adrenal response to surgery in patients with a long-term history of steroid use have been noted. This paper discusses use of the metyrapone test to identify patients with adrenal suppression who may require additional steroid coverage perioperatively and empirical steroid dosing regimens.