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Perioperative steroids

Perioperative steroids are steroids that are used before, during or after a surgery. Human steroids are produced by the adrenal gland and are under the direct or indirect control of the hypothalamus, pituitary, and adrenal glands.

The two major classes of steroids that have significant clinical metabolic effects are the glucocorticoids (mainly cortisol), which regulate glucose and other anabolic cascades, and the mineralocorticoids (mainly aldosterone), which handle Na and K equilibrium.

Patients can become deficient in steroid production through primary Addison’s disease (e.g., adrenal cortex destruction, hemorrhage) or secondary Addison’s disease (e.g., through a deficiency of corticotropin or adrenocorticotropic hormone [ACTH] or through exogenous steroid administration).

Primary Addison’s disease is rare, but secondary Addison’s disease is not uncommon. Perioperative steroids are exogenous glucocorticoids that are used in a variety of diseases including organ and bone transplants, rheumatoid arthritis, systemic lupus erythematosus and other collagen vascular disorders, psoriasis, chronic obstructive pulmonary disease, inflammatory bowel disease, and many hematological diseases such as idiopathic thrombocytopenic purpura (ITP).

What to Do in case of Perioperative steroids

Although the indications and dosages of stress dose steroids mostly perioperative steroids for these patients undergoing surgery is an area of active discussion, it is imperative that the astute clinician knows perioperative steroids history so that an informed decision can be made.

Acute adrenal insufficiency is a morbid and sometimes fatal condition that can be manifested by circulatory collapse, fever, hypoglycemia, and depressed mental status.

Because of the seriousness of this condition and the relative ease of adequately treating it prophylactically, all patients should be specifically queried as to whether they have ever been on perioperative steroids and if so, how much and when.

Some experienced clinicians feel the level of adrenal functioning remains decreased if an equivalent of 5 mg of prednisone was administered for at least 2 weeks in the previous year.

One final note is that 1 mg of dexamethasone equals 5 mg of prednisone, which equals 25 mg of hydrocortisone (which is similar to natural cortisol).

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