Supplemental perioperative steroids for surgical patients with adrenal insufficiency.
BACKGROUND
Adrenal crisis is a life threatening condition which can be induced by stress during surgery in patients with adrenal insufficiency. This may be prevented by perioperative administration of high doses of steroids. There is disagreement on whether supplemental perioperative steroids are required and, when administered, on the amount and frequency of doses.


OBJECTIVE
To assess whether it is necessary to administer supplemental perioperative steroids in adult patients on maintenance doses of glucocorticoids because of adrenal insufficiency.


METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 1); MEDLINE (1966 to January 2009); EMBASE (1980 to January 2009); LILACS (1982 to January 2009); and the databases of ongoing trials. We handsearched the Journal of Clinical Endocrinology and Metabolism (1982 to 1997), Clinical Endocrinology (1972 to 1997), Surgery (1948 to 1994), Annals of Surgery (1948 to 1994), and Anaesthesia (1948 to 2000).


METHODS
Randomized, controlled trials that compared the use of supplemental perioperative steroids to placebo in adult patients on maintenance doses of steroids who required surgery.


METHODS
Two review authors independently assessed trial quality and extracted data. Study authors were contacted for missing information. We used mean differences and standard deviations to summarize the data for each group.


RESULTS
Two trials involving 37 patients were included. These studies reported that supplemental perioperative steroids were not required during surgery for patients with adrenal insufficiency. Neither study reported any adverse effects or complications in the intervention and control groups.


CONCLUSIONS
Owing to the small number of patients, the results may not be representative. Based on current available evidence, we are unable to support or refute the use of supplemental perioperative steroids for patients with adrenal insufficiency during surgery.
Yong
Sin Leong
SL
Oral and Maxillofacial Surgery, School of Dentistry, The University of Manchester, Higher Cambridge Street, Manchester, UK, M15 6FH.
Marik
Paul
P
Esposito
Marco
M
Coulthard
Paul
P
D000309:Adrenal Insufficiency / Q000188:drug therapy* / Q000517:prevention & control; D000328:Adult; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D019990:Perioperative Care; D016032:Randomized Controlled Trials as Topic
D005938:Glucocorticoids