Glucocorticoid Deficiency

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clinical causes
clinical manifestations
anesthetic management

Clinical causes:

Primary adrenal insufficiency:
-Addison's disease (decreased cortisol and decreased aldosterone)

Secondary adrenal insufficiency:
-ex. iatrogenic
-ex. excessive exogenous amount of steroid

Clinical manifestations:

Decreased aldosterone may involve:
-hyponatremia
-hypovolemia
-hyperkalemia
-metabolic acidosis

Decreased cortisol may involve:
-weakness
-fatigue
-hypoglycemia
-hypotension
-weight loss

Addisonian crisis:
-circulatory collapse
-fever
-hypoglycemia
-decreased mentation

Anesthetic management:

-steroid replacement therapy for patients previously taking suppressive doses of steroids (ex. prednisone 5mg daily)

Suggested treatment may involve:
-hydrocortisone phosphate 100 mg q 8 hrs before surgery or morning of surgery

Alternative treatment may include:
-hydrocortisone 25 mg IV @ induction
-then hydrocortisone 100mg IV given over 24 hrs