How much glucocorticoids can a patient have taken and still have a functional hypothalamic-pituitary-adrenal (HPA) axis in the perioperative period?
The hypothalamic-pituitary-adrenal (HPA) axis is critical for generating an appropriate stress response to surgery. Patients who are taking or who have taken exogenous steroids are at risk of secondary adrenal insufficiency and possible perioperative adrenal crisis. Not all patients need supplemental “stress dose steroids”. You will need to determine which patients need further testing and supplemental dosing of glucocorticoids in the perioperative period.
- Order testing to assess HPA axis function only in patients with unknown HPA axis function
- Properly dose supplemental glucocorticoids in patients with suppressed HPA axis function
Review cases 8 & 9 for this section of the module.
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