Hypothalamic-pituitary-adrenal suppression after short-term dexamethasone therapy for oral surgical procedures

Ten patients were given dexamethasone therapy for prevention of postoperative complications after oral surgical procedures. The hypothalamic-pituitary-adrenal response of the patients was measured by their response to a single-dose metyrapone test. A significant difference was found between preoperative values of 11-deoxycortisol and values three days postoperatively. No difference was found when comparing preoperative values of 11-deoxycortisol with values seven days postoperatively. There appears to be an initial suppression of the normal feedback mechanism of the hypothalamic-pituitary-adrenal axis followed by a complete return of normal functioning by the seventh postoperative day. The amount of surgical stress involved in these routine oral surgical procedures is of an insufficient magnitude to overcome this hypothalamic-pituitary-adrenal suppression of the negative feedback mechanism caused by dexamethasone therapy. The presence of adequate amounts of synthetic steroids at a cellular level appears to prevent manifestations of adrenal insufficiency despite suppression of endogenous production of steroids.