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Steroid dependence (Periop management (Continue steroid replacement…
Steroid dependence
Periop management
Continue steroid replacement (Hydro/Pred/Methpred/Dexa 1:4:5:40). Equiv 20mg Hydrocort req for replacemnt
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Physiology
Normal cortisol production: Hypothalamus CRH - Pituitary ACTH - Adrenal cortex Cortisol (10mg produced/day)
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Role of Cortisol
Metabolism of CHO, lipids, proteins
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Adrenal insufficiency
Primary (Addisons) - autoimmune, affecting adrenal cortex
Secondary (Pituitary / Hypothalamic) - Deficiency of CRH or ACTH - atrophy of adrenal zona F only - reduced Cortisol
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Supplementation
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Max 3 days in uncomplicated surgery (due to risk hyperglycaemia, poor wound healing, infection, physiolog effect)