Steroid-dependent patients with multiple co-morbidities are more vulnerable to adrenal crisis

White, Katherine; Wass, John

doi:10.1530/endoabs.38.p416

Cited by 1 publication

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“…In the only prospective study to date, the incidence of adrenal crisis in a cohort of 423 patients with primary and secondary adrenal insufficiency was 8.3 per 100 replacement years, and two patients died during adrenal crisis during a 2‐year follow up .…”

Section: Clinical Outcome In Patients With Adrenal Insufficiency and mentioning

confidence: 99%

“…In a recent British survey, 8.6% of patients with chronic adrenal insufficiency reported a previous adrenal crisis caused by insufficient glucocorticoid medication during an inpatient stay, e.g. for elective surgery . While some of these cases were related to inadequate dosing, others were due to medication errors and omissions on the wards.…”

Section: Clinical Outcome In Patients With Adrenal Insufficiency and mentioning

confidence: 99%

“…for elective surgery [20]. While some of these cases were related to inadequate dosing, others were due to medication errors and omissions on the wards.…”

Section: Why Was This Guideline Developed?mentioning

confidence: 99%

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Guidelines for the management of glucocorticoids during the peri‐operative period for patients with adrenal insufficiency

et al. 2020

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Summary These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri‐operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone‐producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin‐releasing hormone secretion by the hypothalamus (failure of the regulatory centres). Patients taking physiological replacement doses of corticosteroids for either primary or secondary adrenal insufficiency are at significant risk of adrenal crisis and must be given stress doses of hydrocortisone during the peri‐operative period. Many more patients other than those with adrenal and hypothalamic–pituitary causes of adrenal failure are receiving glucocorticoids as treatment for other medical conditions. Daily doses of prednisolone of 5 mg or greater in adults and 10–15 mg.m−2 hydrocortisone equivalent or greater in children may result in hypothalamo–pituitary–adrenal axis suppression if administered for 1 month or more by oral, inhaled, intranasal, intra‐articular or topical routes; this chronic administration of glucocorticoids is the most common cause of secondary adrenal suppression, sometimes referred to as tertiary adrenal insufficiency. A pragmatic approach to adrenal replacement during major stress is required; considering the evidence available, blanket recommendations would not be appropriate, and it is essential for the clinician to remember that adrenal replacement dosing following surgical stress or illness is in addition to usual steroid treatment. Patients with previously undiagnosed adrenal insufficiency sometimes present for the first time following the stress of surgery. Anaesthetists must be familiar with the symptoms and signs of acute adrenal insufficiency so that inadequate supplementation or undiagnosed adrenal insufficiency can be detected and treated promptly. Delays may prove fatal.

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Section: Clinical Outcome In Patients With Adrenal Insufficiency and mentioning

confidence: 99%

Section: Clinical Outcome In Patients With Adrenal Insufficiency and mentioning

confidence: 99%

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Guidelines for the management of glucocorticoids during the peri‐operative period for patients with adrenal insufficiency

et al. 2020

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show abstract

Steroid-dependent patients with multiple co-morbidities are more vulnerable to adrenal crisis

Cited by 1 publication

References 0 publications

Guidelines for the management of glucocorticoids during the peri‐operative period for patients with adrenal insufficiency

Guidelines for the management of glucocorticoids during the peri‐operative period for patients with adrenal insufficiency

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