[Perioperative steroid substitution in patients with adrenal cortex diseases].
OBJECTIVE
To provide clinically feasible recommendations for diagnosis and replacement therapy with glucocorticoids in patients with adrenocortical disease and primary, secondary or iatrogenic adrenocortical failure.


METHODS
Personal clinical experiences and major clinical reviews pertinent to the problem.


RESULTS
The internationally recommended therapeutic regimens are often controversial. Therefore, emphasis is put on detailed and reliable therapeutic schemes which consider the increased glucocorticoid requirement of patients with adrenocortical failure in perioperative or stressful conditions. A sufficient steroid cover is essential to prevent an acute adrenal crisis. It has to be taken into account that adrenocortical dysfunction frequently goes unrecognized in the emergency condition of critical illness if the possibility of its presence is not borne in mind. Moreover, special attention has to be paid, in particular, to the inadvertent corticosteroid withdrawal and its sequelae.


CONCLUSIONS
The perioperative management of patients with diseases of the adrenal cortex is a continuing challenge to the interdisciplinary cooperation of surgeon, neurosurgeon, gynecologist, anesthesiologist and internist.
Jungmann
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Abteilung für Endokrinologie, Klinikum der Johann-Wolfgang-Goethe-Universität Frankfurt/M., BRD.
D000304:Adrenal Cortex Function Tests; D000305:Adrenal Cortex Hormones / Q000097:blood; D000309:Adrenal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011300:Preoperative Care
D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids
Perioperative Steroidsubstitution bei Patienten mit Nebennierenrindenerkrankungen.