Defining and focusing perioperative steroid supplementation

Glucocorticoids, for any number of medical or surgical problems, are commonly given in the management of patients to avoid the potential consequences of adrenal insufficiency caused by exogenous glucocorticoid administration, and especially in the perioperative period. Although the role for increased glucocorticoids during stressors such as surgery is unclear, the administration of steroids to patients with adrenal insufficiency is still a standard of practice. However, there is a medical cost: inhibiting immune function, exacerbating underlying medical disease. Clearer delineation of adrenal insufficiency and appropriate dosing must occur to gain a more accurate perspective on the benefits of stressor glucocorticoid therapy.