Home » 3) Endocrine Disorders » Perioperative Management of Patients on Corticosteroids

Perioperative Management of Patients on Corticosteroids

Guiding Question:
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.

 

Learning Objectives:

  • 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.

 

Learning Resources:
Readings:

  1. UpToDate Chapter: The Surgical Patient Taking Glucocorticoids

Videos: (total viewing time 8:11 )

  1. Perioperative Management of Patients Taking Glucocorticoids (8:11)

Annotated PowerPoint Slides: (Note: To download the slides click “Save” at the top of the presentation. After downloading, click on “View” tab and view as “Notes Page”)

  1. Perioperative Management of Patients Taking Glucocorticoids (10 Slides)
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