Perioperative Evaluation and Treatment of Adrenal Insufficiency-References

References

Pdf Summary

The references collectively address topics surrounding glucocorticoid use, perioperative management, adrenal insufficiency, and associated complications. Key themes include the physiological role of the hypothalamic-pituitary-adrenal (HPA) axis (Refs 2, 8, 9, 11), the pharmacology and dosing of glucocorticoids (Refs 3, 25), and their effects on immune cells such as neutrophils (Ref 4). Several studies discuss the measurement of cortisol levels and the diagnosis of adrenal insufficiency (Refs 5, 10, 21). <br /><br />Perioperative glucocorticoid management is a major focus, with guidelines and evidence reviews evaluating the necessity and optimal dosing of stress-dose steroids to prevent adrenal crises during surgery (Refs 6, 7, 12-17, 22-24). The literature debates the myths surrounding routine perioperative steroid supplementation and emphasizes individualized approaches based on risk assessment (Refs 6, 15, 17). <br /><br />Some references highlight the risks and benefits of corticosteroid use in specific surgical settings, such as cardiac surgery and renal transplant (Refs 26, 27, 29), while others examine adverse effects from long-term glucocorticoid therapy (Ref 28). There is also discussion of adverse events including infection risk post-arthroplasty in rheumatoid arthritis patients on steroids (Ref 30). <br /><br />The literature further covers postoperative complications like nausea, vomiting, and sore throat, with studies showing dexamethasone’s role in their prevention and analgesic enhancement (Refs 32-36). Finally, rare clinical presentations such as Addisonian crisis despite high-dose glucocorticoids are reported (Ref 37). <br /><br />Overall, these studies and guidelines emphasize a nuanced understanding of glucocorticoid physiology, careful perioperative management tailored to individual patient risks, and awareness of both therapeutic benefits and potential harms associated with corticosteroid use in surgical and clinical practice.

Keywords

glucocorticoid use

perioperative management

adrenal insufficiency

HPA axis

glucocorticoid pharmacology

cortisol measurement

stress-dose steroids

steroid supplementation myths

corticosteroid surgical risks

dexamethasone postoperative complications