Probabilities of Pituitary-Adrenal Responsiveness After Steroid Therapy

Danowski, T. S.; Bonessi, James V.; Sabeh, G.; Sutton, Roger D.; Webster, Marshall W.; Sarver, Margaret E.

doi:10.7326/0003-4819-61-1-11

Cited by 83 publications

(20 citation statements)

References 42 publications

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“…It is considered that corticosteroid therapy inhibits endogenous corticotrophin and may depress adrenocortical activity directly (Danowski, Bonessi, Sabeh, Sutton, Webster, and Sarver, 1964). But Farmer, Hill, Pittman, and Herod (1961) presented evidence that there are two mechanisms concerned with corticotrophin release, one being mediated through the neurohypophysis in response to stress and the other through the pituitary-adrenal 'feed-back system'.…”

Section: Methodsmentioning

confidence: 99%

Effect of Corticosteroid and Corticotrophin Therapy on Adrenocortical Function in Bronchial Asthma

Kilborn¹,

Robson²

1965

Thorax

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Section: Methodsmentioning

confidence: 99%

Effect of Corticosteroid and Corticotrophin Therapy on Adrenocortical Function in Bronchial Asthma

Kilborn¹,

Robson²

1965

Thorax

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“…Danowski et al 24 observed that as much as 300 mg of cortisol daily for 30 days had no detectable effect on the ACTH response. According to them, after courses lasting a year or more spontaneous revival of adrenocortical activity will usually occur within 48 hours.…”

Section: Discussionmentioning

confidence: 99%

Hazards of steroids in association with anaesthesia

Oyama

1969

Can. Anaes. Soc. J.

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SHOCK OR HYPOTENSION under operative stress due to adrenal failure following steroid therapy is now well recognized. 1-~ Confirmation that such episodes are attributable to adrenal failure can come only from a study of plasma cortisol levels during shock or hypotension. Direct evidence of this has been scanty and difficult to acquire.There are several points to be resolved: (a) Do we frequently observe arterial hypotension during or after operative stress in patients previously treated with steroid when no steroid is given? (b) Is the operative hypotension the result of real adrenal insufficiency? (c) What are the factors which contribute to adrenal failure under surgical stress? Do they include the duration of steroid treatment, the dosage, the method of administration? The present study was undertaken to investigate these problems by determining plasma cortisol (-'-hydrocortisone) levels during anaesthesia and operation in patients treated with steroid. METHODFourteen patients who underwent various operations were studied as shown in Table I. These patients had been treated with steroids at some period up to 297 days prior to operation. None of them received steroids on the day before operation or on the day of surgery. A group of ten patients who had no history of steroid therapy in the past and who had operations served as a control.Each patient in both groups was premedieated with pentobarbital 50-100 mg orally at night and 1,~ ' hours prior to the induction of anaesthesia. Meperidine 35 mg and atropine 0.5 mg were given by intramuscular injection 1~I hours before the induction of anaesthesia. Due to the diurnal variations of the concentration of free cortisol in the plasma in man, induction of anaesthesia was started at 8:30 A.~. Anaesthesia was induced with halothane (0.5-2 per cent), nitrous oxide (2 L/m), and oxygen (2 L/m) under a mask, followed by succinylcholine chloride (scc) 40 mg intravenously for endotracheal intubation. Anaesthesia was maintained with halothane, nitrous oxide, and oxygen, combined with intermittent scc injection whenever needed. Ventilation was controlled or assisted throughout the procedure. A moderate depth of anaesthesia was maintained during each procedure by clinical judgment and occasional eleetroencephalographic monitoring.Determination of free eortisol (17-hydroxycorticosteroid ---17-OHCS) concentration in the plasma was made for 1 ml of plasma by Rudd's fluorimetric method 4 with a Farrand spectroftuorimeter, using an activating wavelength of 470 m/z and a fluorescent wavelength of 530 m/z. Two determinations were made on

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“…26 It is commonly believed that the recovery in plasma ACTH is seen earlier than that in plasma cortisol level. 29 Danowski et at, 21 applying the Metopirone test in 196 steroid treated patients, could not detect any pituitary-adrenal hypofunction when cortisol 20 mg per day had been administered for several years. These patients underwent major surgical operation safely without receiving steroid cover.…”

Section: !mentioning

confidence: 97%

“…8 Vandam and Moore 20 stated that any patient who has been on cortisone therapy for four days or longer or cortisone therapy within the past six months may be considered to have subnormal adrenocortical function. Danowski et al 21 observed that as much as 300 mg of cortisol daily for 30 days had no detectable effect on the ACTH response. According to them, after courses lasting a year or more spontaneous revival of adrenocortical activity will usually occur within 48 hours.…”

Section: !mentioning

confidence: 99%

Prediction of adrenal hypofunction in anaesthesia

Oyama

Takiguchi

1972

Canad. Anaesth. Soc. J.

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IT HAS BEEN SUSPECTED THAT PATIENTS with adrenocortical insufficiency have been increasing in number because of increased therapeutic use of adrenal steroids and the performance of adrenalectomy or hypophysectomy for treatment of certain diseases. This has produced a growing probability of encountering iatrogenic diseases or disorders. Among them adrenal insufficiency during or after anaesthesia and surgery is the most dangerous complication, characterized mainly by arterial hypotension and tachycardia and terminating in shock or death. 1 Therefore, if we could find an appropriate method of predicting adrenocortical hypofunction preoperatively, it would improve the safety of anaesthetic management of steroid-treated patients. The present study was undertaken to investigate a possibility to predict and to prevent adrenal hypofunction during anaesthesia in patients treated with steroid. METHOD Seventy-nine subjects were involved; 30 subjects served as controls, and 39 patients previously treated with steroid who underwent various operations were studied, as shown in Table I These 39 patients had been treated with steroid at some period up to 8 years prior to operation. The total amount of glucocorticoids expressed as equivalent to cortisol ranged from 1.0 gm to 732.4 gm. None of them received steroids on the day before operation or on the day of surgery. In addition a group of ten patients who had no history of steroid therapy in the past and who had operations served as a control.Each patient in both groups was premedicated with pentobarbital 50-100 mg orally at night and 1% hours prior to the induction of anaesthesia. Meperidine 35 mg and atropine 0.5 mg were given by intramuscular injection 1& hours before the induction of anaesthesia. Due to the diurnal variations of the concentration of free cortisol in the plasma in man, induction of anaesthesia was started at 8:30 AM. Anaesthesia was induced with halothane (0.5-2 per cent), nitrous oxide (2 litres/min), and oxygen (2 litres/min) under a mask, followed by succinylcholine chloride (SCC) 40 mg intravenously for endotracheal intubation. Anaesthesia was maintained with halothane, nitrous oxide, and oxygen, combined with intermittent SCC injection whenever needed-Ventilation was controlled or assisted throughout the procedure. A moderate depth of anaesthesia was maintained during each procedure by clinical judgment and occasional electroencephalographic monitoring.Determination of free cortisol (17-hydroxycorticosteroid = 17-OHCS) concentration in 1 ml plasma by Rudd's fluorimetric method 2 and six blood sampling times were similar to that previously reported. 1 For the protection of adrenocor-

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Probabilities of Pituitary-Adrenal Responsiveness After Steroid Therapy

Cited by 83 publications

References 42 publications

Effect of Corticosteroid and Corticotrophin Therapy on Adrenocortical Function in Bronchial Asthma

Effect of Corticosteroid and Corticotrophin Therapy on Adrenocortical Function in Bronchial Asthma

Hazards of steroids in association with anaesthesia

Prediction of adrenal hypofunction in anaesthesia

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