Treatment of Central Adrenal Insufficiency During Minor to Moderate Surgical Stress

This protocol addresses patients with known adrenal insufficiency who are scheduled for a surgical procedure involving minor to moderate physiological stress. The impaired cortisol response in this population requires a specific perioperative approach to prevent adrenal crisis.

In the setting of minor to moderate surgical stress, adrenal insufficiency places the patient at risk of an inadequate stress cortisol response. The management strategy accounts for both the severity of the underlying condition and the magnitude of the surgical stressor.

Management involves hydrocortisone supplementation, with the dose on the day of surgery calibrated to the severity of illness and the magnitude of the stressor. The complete dosing regimen, duration, and adjustment algorithm are available in the full protocol below.