Fatal Adrenal Cortical Insufficiency Precipitated by Surgery During Prolonged Continuous Cortisone Treatment

Lewis, Leon; Robinson, Robert F.; Yee, James; Hacker, Lucy A.; Eisen, George

doi:10.7326/0003-4819-39-1-116

Cited by 165 publications

(14 citation statements)

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“…But tradition and historically based repetition of policies may suffer from a lack of awareness of the origin of the policy or subsequent evidence-based experiences. By example, the use of empirical stress-dose glucocorticoids for pituitary surgery appears to have developed in the following way: recommendations for using high dose glucocorticoids in surgery began after two reports in the late 1950s for patients with likely adrenal suppression (Fraser et al, 1952; Lewis et al, 1953). Both reports describe the post-operative death of patients who had been on high dose cortisone prior to orthopedic surgery.…”

Section: Discussionmentioning

confidence: 99%

Selective Use of Peri-Operative Steroids in Pituitary Tumor Surgery: Escape from Dogma

Regan¹,

Watson²

2013

Front. Endocrinol.

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Objective: Traditional neurosurgical practice calls for administration of peri-operative stress-dose steroids for sellar-suprasellar masses undergoing operative treatment. This practice is considered critical to prevent peri-operative complications associated with hypoadrenalism, such as hypotension and circulatory collapse. However, stress-dose steroids complicate the management of these patients. It has been our routine practice to use stress steroids during surgery only if the patient has clinical or biochemical evidence of hypocortisolism pre-operatively. We wanted to be certain that this practice was safe.Methods: We present our retrospective analysis from a consecutive series of 114 operations in 109 patients with sellar and/or suprasellar tumors, the majority of whom were managed without empirical stress-dose steroid coverage. Only patients who were hypoadrenal pre-operatively or who had suffered apoplexy were given stress-dose coverage during surgery. We screened for biochemical evidence of hypoadrenalism as a result of surgery by measuring immediate post-operative AM serum cortisol levels.Results: There were no adverse events related to the selective use of cortisol replacement in this patient population.Conclusion: Our experience demonstrates that selective use of corticosteroid replacement is safe; it simplifies the management of the patients, and has advantages over empiric “dogmatic” steroid coverage.

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Section: Discussionmentioning

confidence: 99%

Selective Use of Peri-Operative Steroids in Pituitary Tumor Surgery: Escape from Dogma

Regan¹,

Watson²

2013

Front. Endocrinol.

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“…Furthermore, there are few data available regarding the true incidence of perioperative adrenal insufficiency, especially in the field of reconstructive surgery. Since the potential danger of long-term steroid therapy in surgical patients was described by Fraser et al 16 and Lewis et al 17 in 1952 and 1953, a stress dose of GCs was advised to prevent adrenal insufficiency perioperatively. According to Salem et al, 18 the dose of perioperative steroid coverage depends on the degree of surgical stress.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Glucocorticoid Treatment of Soft Tissue Reconstruction in Patients on Long-term Steroid Therapy

Zhang

et al. 2018

Annals of Plastic Surgery

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IntroductionLong-term steroid therapy is associated with increased postoperative morbidity. Whether to use a stress dose of glucocorticoids (GCs) in surgical patients remains controversial. In the present study, we reported our experience in perioperative GC treatment of 6 patients on long-term steroid therapy for autoimmune diseases undergoing hand reconstruction using reversed interosseous flap.MethodsThe reversed interosseous flap reconstructions were performed after local extended resection of hand neoplasms. The patients were all diagnosed with autoimmune diseases and were undergoing long-term steroid therapy. Stress dose of GCs was not given in any case, and all the patients either remained on their baseline maintenance dose or decreased the dose until the morning of the operation day. Hypotension, water-electrolyte imbalance, hypoglycemia, and other symptoms of adrenal insufficiency were carefully assessed. Appearances of flap complications were recorded.ResultsNone of the patients developed hypotension or other symptomatic adrenal insufficiency. Flap infection, venous congestion, or complete or partial loss of flap was not observed in any patient. Effusion underneath the flap was developed in only 1 case and was solved by proper drainage.ConclusionsIt is safe, reliable, and versatile to use reversed interosseous flap to repair hand defects in patients on long-term steroid therapy. A stress dose of GCs might not be necessary in this procedure and other equally moderate soft tissue reconstructive surgeries.

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“…The administration of “stress-dose” corticosteroids to IBD patients in the perioperative period, even with limited prior corticosteroid exposure, has become a common practice. The historical context for this widespread practice dates back to the 1950s with the publication of two case reports of fatalities presumably related to adrenal crises among corticosteroid-dependent patients who did not receive corticosteroid supplementation postoperatively [ 31 , 32 ]. These case reports were not questioned, and stress dose corticosteroids have been commonly administered.…”

Section: Aminosalicylatesmentioning

confidence: 99%

Perioperative use of immunosuppressive medications in patients with Crohn's disease in the new "biological era"

Lightner

Shen

2017

Gastroenterology Report

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Crohn’s disease (CD) is characterized by transmural inflammation of the gastrointestinal tract leading to inflammatory, stricturing and/or and fistulizing disease. Once a patient develops medically refractory disease, mechanical obstruction, fistulizing disease or perforation, surgery is indicated. Unfortunately, surgery is not curative in most cases, underscoring the importance of bowel preservation and adequate perioperative medical management. As many of the medications used to treat CD are immunosuppressive, the concern for postoperative infectious complications and anastomotic healing are particularly concerning; these concerns have to be balanced with preventing and treating residual or recurrent disease. We herein review the available literature and make recommendations regarding the preoperative, perioperative and postoperative administration of immunosuppressive medications in the current era of biological therapy for CD. Standardized algorithms for perioperative medical management would greatly assist future research for optimizing surgical outcomes and preventing disease recurrence in the future.

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Fatal Adrenal Cortical Insufficiency Precipitated by Surgery During Prolonged Continuous Cortisone Treatment

Cited by 165 publications

References 0 publications

Selective Use of Peri-Operative Steroids in Pituitary Tumor Surgery: Escape from Dogma

Selective Use of Peri-Operative Steroids in Pituitary Tumor Surgery: Escape from Dogma

Perioperative Glucocorticoid Treatment of Soft Tissue Reconstruction in Patients on Long-term Steroid Therapy

Perioperative use of immunosuppressive medications in patients with Crohn's disease in the new "biological era"

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