Acute adrenal insufficiency following cardiac surgical procedures

Wc, Alford; Ck, Meador; Mihalevich, J; Gr, Burrus; Dm, Glassford; Sw, Stoney; Cs, Thomas

doi:10.1016/s0022-5223(19)38074-2

Cited by 48 publications

(5 citation statements)

References 13 publications

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“…A number of case series studies have described hemodynamic improvement after cortisol replacement therapy that followed diagnosis of AI. 3,11,28,54 Bollaert et al 55 showed reversal of severe late septic shock (improved hemodynamics) and a beneficial effect on mortality with hydrocortisone therapy. As confirmed in this study, an important therapeutic benefit of early diagnosis and treatment is the potential to decrease the need for administering high doses of vasopressor therapy with its possible negative consequences.…”

Section: Discussionmentioning

confidence: 99%

Adrenal Insufficiency in High-Risk Surgical ICU Patients

Rivers

Gaspari

Mlynarek

et al. 2001

CHEST

140

116

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Section: Discussionmentioning

confidence: 99%

Adrenal Insufficiency in High-Risk Surgical ICU Patients

Rivers

Gaspari

Mlynarek

et al. 2001

CHEST

140

116

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“…With a lack of randomized controlled studies evaluating glucocorticoid dose requirements perioperatively in adrenally insufficient patients, regimens derive from physiological cortisol secretion data. Literature recommendations vary between 2 and 10 times the normal physiological secretory rate and recommended doses are in excess of the estimated increase in plasma cortisol concentrations in response to surgery 13,42,43 . Studies looking at the secretory rate of cortisol have obtained a range of normative values.…”

Section: Steroid Dosingmentioning

confidence: 99%

“…Literature recommendations vary between 2 and 10 times the normal physiological secretory rate and recommended doses are in excess of the estimated increase in plasma cortisol concentrations in response to surgery. 13,42,43 Studies looking at the secretory rate of cortisol have obtained a range of normative values. A widely cited value is 12.5 ± 3 mg/m 2 of body surface area per day in children and adults.…”

Section: S Teroiddos Ingmentioning

confidence: 99%

Peri‐operative steroid management in the paediatric population

Heath

Siafarikas

Sommerfield

et al. 2021

Acta Anaesthesiol Scand

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Background Patients with adrenal insufficiency are at risk of adrenal crisis, a potentially life‐threatening emergency in the peri‐operative period due to their attenuated ability to mount a cortisol response. There is a lack of standardization regarding peri‐operative stress‐dose glucocorticoids in paediatric clinical practice with the absence of agreed protocols. For the individual patient, the risk of adrenal crisis must be weighed against the potential adverse clinical outcomes associated with unnecessary or supra‐physiologic glucocorticoid dosing in susceptible patients. Specific clinical concerns in the paediatric population include osteopenia, growth restriction and increased risk of cardiovascular disease in adulthood. This review aimed to identify and evaluate available literature in the field of peri‐operative stress‐dose glucocorticoids. Methods A comprehensive literature search was conducted to construct a narrative review. Results The outcome of this review identified that paediatric patients, unlike adults, do not show a graded response to surgical stress with implications for glucocorticoid stress dose regimens for general anaesthesia and less invasive surgical procedures. The studies highlight a lack of information on physiological steroid responses to stress situations and differences in the approach to glucocorticoid replacement strategies in the paediatric population. Conclusion The review identified there is a lack of high‐quality paediatric‐specific studies evaluating appropriate stress‐dose glucocorticoid regimens in paediatric patients with or at risk of adrenal insufficiency. Further research is needed to establish clear evidence‐based clinical guidelines for paediatric peri‐operative practice regarding steroid stress dosing in adrenal insufficiency. Current knowledge would suggest that a balanced view of risks and benefits should be taken appropriate to the clinical context, to dictate peri‐operative stress‐dose glucocorticoids use that permits safe perioperative management.

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“…La incidencia de insuficiencia suprarrenal intraoperatoria en pacientes que utilizan corticoides crónicamente es baja 23 , ocurriendo aproximadamente en 0,01% de las cirugías urológicas 27 y 0,1% de las cardíacas 28 .…”

Section: Uso Crónico De Corticoidesunclassified

Manejo Perioperatorio De Pacientes Con Patología Tiroidea Y Tratamiento Crónico Con Corticoides

et al. 2016

Rev Chil Cir

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Perioperative management in patients with thyroid disorders and chronic glucocorticoid therapyThyroid disorders and chronic use of corticosteroids are common in the surgical population, so is necessary an appropriate perioperative management of these patients. There is no contraindication for elective surgery in patients with asymptomatic hypothyroidism and good control, it is not necessary to maintain the levothyroxine dose the day of surgery, due to the pharmacokinetic properties of the drug. If hypothyroid patients are symptomatic and/or have not reached the euthyroid phase, should be treated and compensated prior to the elective surgical procedure. Patients with hyperthyroidism should keep their antithyroid treatment including the day of surgery. The symptomatic and/or decompensated hyperthyroidism have an increased risk of developing a thyroid storm, so no elective surgery is recommended in these patients, which should be conducted once achieved an euthyroid state. A strict monitoring in the postoperative period is key to prevent complications. Chronic glucocorticoid use is common. In these patients there is risk of developing acute adrenal insufficiency by surgical stress, so before surgery (elective or emergency) it is necessary to supplement with exogenous corticosteroid dose dependent on the type of surgical procedure performed.resumen Los trastornos tiroideos y el uso crónico de corticoides son frecuentes en la población quirúrgica, por lo que es necesario un manejo perioperatorio adecuado en este tipo de pacientes. no existe contraindicación para una cirugía electiva en pacientes con hipotiroidismo asintomáticos y buen control, no siendo necesario

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Acute adrenal insufficiency following cardiac surgical procedures

Cited by 48 publications

References 13 publications

Adrenal Insufficiency in High-Risk Surgical ICU Patients

Adrenal Insufficiency in High-Risk Surgical ICU Patients

Peri‐operative steroid management in the paediatric population

Manejo Perioperatorio De Pacientes Con Patología Tiroidea Y Tratamiento Crónico Con Corticoides

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