Management of adrenal insufficiency during the stress of medical illness and surgery

Abstract

• Patients with adrenal insufficiency (AI) require additional glucocorticoid doses during surgery or medical illness, but there is no universally accepted regimen for glucocorticoid supplementation therapy. • The high doses and long duration of glucocorticoid coverage that have traditionally been used do not reflect the hypothalamic-pituitary-adrenal response to surgical stress and medical illness in normal people. • While the optimal dose and duration of supplementation therapy have not been established, our recommendations are based on extrapolation from what constitutes a normal cortisol response to stress, on expert opinion derived from the medical literature, and on clinical experience...