[Perioperative steroid substitution in patients with adrenal cortex diseases]

To provide clinically feasible recommendations for diagnosis and replacement therapy with glucocorticoids in patients with adrenocortical disease and primary, secondary or iatrogenic adrenocortical failure.

Personal clinical experiences and major clinical reviews pertinent to the problem.

The internationally recommended therapeutic regimens are often controversial. Therefore, emphasis is put on detailed and reliable therapeutic schemes which consider the increased glucocorticoid requirement of patients with adrenocortical failure in perioperative or stressful conditions. A sufficient steroid cover is essential to prevent an acute adrenal crisis. It has to be taken into account that adrenocortical dysfunction frequently goes unrecognized in the emergency condition of critical illness if the possibility of its presence is not borne in mind. Moreover, special attention has to be paid, in particular, to the inadvertent corticosteroid withdrawal and its sequelae.

The perioperative management of patients with diseases of the adrenal cortex is a continuing challenge to the interdisciplinary cooperation of surgeon, neurosurgeon, gynecologist, anesthesiologist and internist.