Defining and focusing perioperative steroid supplementation

Area of Science:

• Endocrinology
• Pharmacology
• Surgical Management

Background:

• Glucocorticoids are frequently administered to patients undergoing medical or surgical procedures.
• This is done to mitigate risks associated with adrenal insufficiency, particularly in the perioperative setting.
• The standard practice of steroid administration in patients with adrenal insufficiency persists despite unclear benefits during stressors.

Purpose of the Study:

• To examine the established practice of administering glucocorticoids to patients with adrenal insufficiency during stressful events like surgery.
• To highlight the potential adverse effects of stressor glucocorticoid therapy, including immune suppression and exacerbation of comorbidities.
• To advocate for a more precise understanding of adrenal insufficiency and optimized dosing strategies.

Main Methods:

• Review of current clinical practices regarding glucocorticoid administration in patients with adrenal insufficiency.
• Analysis of the known and potential consequences of exogenous glucocorticoid use.
• Literature review on the role of glucocorticoids during physiological stressors.

Main Results:

• Exogenous glucocorticoid administration is a common strategy to prevent adrenal insufficiency complications, especially perioperatively.
• The necessity and benefit of increased glucocorticoids during surgical stressors remain uncertain.
• Current steroid therapy carries risks, including immune inhibition and worsening of underlying medical conditions.

Conclusions:

• The standard practice of administering glucocorticoids during stressors to patients with adrenal insufficiency requires critical reassessment.
• Further research is needed to delineate adrenal insufficiency more clearly and establish appropriate dosing.
• Optimizing glucocorticoid therapy is essential for a balanced perspective on its benefits versus risks.