Treatment of Central Adrenal Insufficiency in Major Surgical Stress
Major surgery represents one of the highest physiological stress loads encountered in clinical practice. In a patient with adrenal insufficiency, the inability to mount an adequate endogenous cortisol response during this stress demands prompt, structured intravenous glucocorticoid coverage.
Clinical scenario: A patient with known adrenal insufficiency is undergoing major surgery. The operative stress far exceeds what standard maintenance dosing can cover, placing the patient at risk of adrenal crisis without specific perioperative intervention.
Approach: Intravenous hydrocortisone is the recommended agent in this setting. Management involves an initial bolus injection followed by continued intravenous coverage — the precise dosing strategy, infusion schedule, and alternative administration options are specified in the full structured protocol.
References
DOI: 10.1210/jc.2016-2118
In cases of major surgical stress, we suggest a 100-mg HC per iv injection followed by a continuous iv infusion of 200 mg HC per 24 hours (alternatively 50 mg every 6 hours iv or im).
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