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Preventing adrenal insufficiency during surgery

R L Byyny

    Postgraduate Medicine
    |May 1, 1980
    PubMed
    Summary
    This summary is machine-generated.

    Adrenal insufficiency involves cortisol and aldosterone deficiency. Patients need glucocorticoid prophylaxis before surgery, with hydrocortisone being the recommended treatment.

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    Area of Science:

    • Endocrinology
    • Internal Medicine

    Background:

    • Primary adrenal insufficiency presents with cortisol and aldosterone deficiency.
    • Secondary adrenal insufficiency involves isolated cortisol deficiency, often caused by steroid therapy.
    • Symptoms like fatigue and hypotension are common, with specific signs differentiating primary from secondary forms.

    Purpose of the Study:

    • To differentiate primary and secondary adrenal insufficiency.
    • To highlight the impact of steroid therapy on adrenal function.
    • To emphasize the necessity of glucocorticoid prophylaxis in patients with adrenal insufficiency.

    Main Methods:

    • Clinical presentation and laboratory findings were reviewed.
    • The etiology of secondary adrenal insufficiency, particularly steroid-induced, was analyzed.

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  • Management strategies, including surgical prophylaxis, were evaluated.

    • Main Results:

    • Cortisol deficiency is the hallmark of secondary adrenal insufficiency, unlike the primary form.
    • Steroid therapy is the leading cause of secondary adrenal insufficiency, with dose and duration correlating with adrenal suppression.
    • Sudden withdrawal of steroids can trigger adrenal crisis.

    Conclusions:

    • Patients with adrenal insufficiency require glucocorticoid supplementation during surgical stress.
    • Hydrocortisone is the preferred glucocorticoid for prophylaxis over cortisone acetate.
    • Continued therapy is essential until adrenocortical function is restored.