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Preoperative Assessment of Adrenal Insufficiency in Glucocorticoid Therapy

Preoperative Assessment of Adrenal Insufficiency in Glucocorticoid Therapy Abstract To the Editor.—Despite the recent findings of Cunningham et al,1 the synthetic adrenocorticotropic hormone (ACTH) test remains the best technique for establishing whether a patient with possible adrenal insufficiency secondary to exogenous glucocorticoid therapy can undergo the stress of surgery without supplemental steroid coverage. Jasani et al2 found in 1968 that the metyrapone and insulin-induced hypoglycemia tests were more sensitive than the ACTH stimulation test in detecting mild degrees of secondary adrenal insufficiency. They studied 21 patients with steroid-treated rheumatoid arthritis undergoing anterior synovectomy of the knee without steroid coverage. Preoperatively, 16 patients had abnormal responses to the metyrapone or insulin-induced hypoglycemia tests, and nine of these 16 patients also had abnormal ACTH stimulation test results. Only one patient, from the group with abnormal responses to the ACTH test, developed intraoperative hypotension associated with a low serum cortisol. These results are further supported by the work of References 1. Cunningham SK, Moore A, McKenna TJ: Normal cortisol response to corticotropin in patients with secondary adrenal failure . Arch Intern Med 1983;143:2276-2279.Crossref 2. Jasani MK, Freeman PA, Boyle JA, et al: Studies of the rise in plasma 11-hydroxycorticosteroids (11-OHCS) in corticosteroid-treated patients with rheumatoid arthritis during surgery: Correlations with the functional integrity of the hypothalamo-pituitary-adrenal axis . Q J Med 1968;37:407-421. 3. Sampson PA, Winstone NE, Brooke BN: Adrenal function in surgical patients after steroid therapy . Lancet 1952;2:322-325. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Preoperative Assessment of Adrenal Insufficiency in Glucocorticoid Therapy

Archives of Internal Medicine , Volume 144 (11) – Nov 1, 1984

Preoperative Assessment of Adrenal Insufficiency in Glucocorticoid Therapy

Abstract

Abstract To the Editor.—Despite the recent findings of Cunningham et al,1 the synthetic adrenocorticotropic hormone (ACTH) test remains the best technique for establishing whether a patient with possible adrenal insufficiency secondary to exogenous glucocorticoid therapy can undergo the stress of surgery without supplemental steroid coverage. Jasani et al2 found in 1968 that the metyrapone and insulin-induced hypoglycemia tests were more sensitive than the ACTH stimulation test in...
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References (3)

Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1984.04400020222050
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor.—Despite the recent findings of Cunningham et al,1 the synthetic adrenocorticotropic hormone (ACTH) test remains the best technique for establishing whether a patient with possible adrenal insufficiency secondary to exogenous glucocorticoid therapy can undergo the stress of surgery without supplemental steroid coverage. Jasani et al2 found in 1968 that the metyrapone and insulin-induced hypoglycemia tests were more sensitive than the ACTH stimulation test in detecting mild degrees of secondary adrenal insufficiency. They studied 21 patients with steroid-treated rheumatoid arthritis undergoing anterior synovectomy of the knee without steroid coverage. Preoperatively, 16 patients had abnormal responses to the metyrapone or insulin-induced hypoglycemia tests, and nine of these 16 patients also had abnormal ACTH stimulation test results. Only one patient, from the group with abnormal responses to the ACTH test, developed intraoperative hypotension associated with a low serum cortisol. These results are further supported by the work of References 1. Cunningham SK, Moore A, McKenna TJ: Normal cortisol response to corticotropin in patients with secondary adrenal failure . Arch Intern Med 1983;143:2276-2279.Crossref 2. Jasani MK, Freeman PA, Boyle JA, et al: Studies of the rise in plasma 11-hydroxycorticosteroids (11-OHCS) in corticosteroid-treated patients with rheumatoid arthritis during surgery: Correlations with the functional integrity of the hypothalamo-pituitary-adrenal axis . Q J Med 1968;37:407-421. 3. Sampson PA, Winstone NE, Brooke BN: Adrenal function in surgical patients after steroid therapy . Lancet 1952;2:322-325.

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1984

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