Management of adrenal insufficiency during the stress of medical illness and surgery

Caroline Jung and Warrick J Inder
Med J Aust 2008; 188 (7): 409-413.
  • Caroline Jung1
  • Warrick J Inder2

  • 1 St Vincent’s Hospital, Melbourne, VIC.
  • 2 Department of Medicine, University of Melbourne, Melbourne, VIC.

Competing interests:

None identified.

  • 1. Addison T. On the constitutional and local effects of diseases of the suprarenal capsules. London: Samuel Highley, 1855.
  • 2. Hench PS, Kendall EC, Slocumb CH, et al. The effect of a hormone of the adrenal cortex (17-hydroxy-11-dehydrocorticosterone: compound E) and of pituitary adrenocorticotrophic hormone on rheumatoid arthritis. Proc Staff Meet Mayo Clin 1949; 24: 181-197.
  • 3. Fraser CG, Preuss FS, Bigford WD. Adrenal atrophy and irreversible shock associated with cortisone therapy. J Am Med Assoc 1952; 149: 1542-1543.
  • 4. Lewis L, Robinson RF, Yee J, et al. Fatal adrenal cortical insufficiency precipitated by surgery during prolonged continuous cortisone treatment. Ann Intern Med 1953; 39: 116-126.
  • 5. Salem M, Tainsh RE Jr, Bromberg J, et al. Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem. Ann Surg 1994; 219: 416-425.
  • 6. Lamberts SW, Bruining HA, de Jong FH. Corticosteroid therapy in severe illness. N Engl J Med 1997; 337: 1285-1292.
  • 7. Coursin DB, Wood KE. Corticosteroid supplementation for adrenal insufficiency. JAMA 2002; 287: 236-240.
  • 8. Arafah BM. Hypothalamic pituitary adrenal function during critical illness: limitations of current assessment methods. J Clin Endocrinol Metab 2006; 91: 3725-3745.
  • 9. Kenny FM, Preeyasombat C, Migeon CJ. Cortisol production rate. II. Normal infants, children, and adults. Pediatrics 1966; 37: 34-42.
  • 10. Esteban NV, Loughlin T, Yergey AL, et al. Daily cortisol production rate in man determined by stable isotope dilution/mass spectrometry. J Clin Endocrinol Metab 1991; 72: 39-45.
  • 11. Kerrigan JR, Veldhuis JD, Leyo SA, et al. Estimation of daily cortisol production and clearance rates in normal pubertal males by deconvolution analysis. J Clin Endocrinol Metab 1993; 76: 1505-1510.
  • 12. Udelsman R, Goldstein DS, Loriaux DL, et al. Catecholamine-glucocorticoid interactions during surgical stress. J Surg Res 1987; 43: 539-545.
  • 13. Jabbour SA. Steroids and the surgical patient. Med Clin North Am 2001; 85: 1311-1317.
  • 14. Donald RA, Perry EG, Wittert GA, et al. The plasma ACTH, AVP, CRH and catecholamine responses to conventional and laparoscopic cholecystectomy. Clin Endocrinol (Oxf) 1993; 38: 609-615.
  • 15. Naito Y, Tamai S, Shingu K, et al. Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology 1992; 77: 426-431.
  • 16. Widmer IE, Puder JJ, König C, et al. Cortisol response in relation to the severity of stress and illness. J Clin Endocrinol Metab 2005; 90: 4579-4586.
  • 17. Arafah BM, Kailani SH, Nekl KE, et al. Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J Clin Endocrinol Metab 1994; 79: 348-354.
  • 18. Udelsman R, Norton JA, Jelenich SE, et al. Responses of the hypothalamic–pituitary–adrenal and rennin–angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress. J Clin Endocrinol Metab 1987; 64: 986-994.
  • 19. Kehlet H. A rational approach to dosage and preparation of parenteral glucocorticoid substitution therapy during surgical procedures. A short review. Acta Anaesthesiol Scand 1975; 19: 260-264.
  • 20. Arlt W, Allolio B. Adrenal insufficiency. Lancet 2003; 361: 1881-1893.
  • 21. Oelkers W. Adrenal insufficiency. N Engl J Med 1996; 335: 1206-1212.
  • 22. Krasner AS. Glucocorticoid-induced adrenal insufficiency. JAMA 1999; 282: 671-676.
  • 23. Stewart PM. The adrenal cortex. In: Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams textbook of endocrinology. 10th ed. Philadelphia: Saunders, 2003: 491-551.
  • 24. LaRochelle GE Jr, LaRochelle AG, Ratner RE, et al. Recovery of the hypothalamic–pituitary–adrenal (HPA) axis in patients with rheumatic diseases receiving low-dose prednisone. Am J Med 1993; 95: 258-264.
  • 25. Schlaghecke R, Kornely E, Santen RT, et al. The effect of long-term glucocorticoid therapy on pituitary-adrenal responses to exogenous corticotropin-releasing hormone. N Engl J Med 1992; 326: 226-230.
  • 26. de Jong FH, Mallios C, Jansen C, et al. Etomidate suppresses adrenocortical function by inhibition of 11 beta-hydroxylation. J Clin Endocrinol Metab 1984; 59: 1143-1147.
  • 27. Crown A, Lightman S. Why is the management of glucocorticoid deficiency still controversial: a review of the literature. Clin Endocrinol (Oxf) 2005; 63: 483-492.
  • 28. Howlett TA. An assessment of optimal hydrocortisone replacement therapy. Clin Endocrinol (Oxf) 1997; 46: 263-268.
  • 29. Bahn SL. Glucocorticosteroids in dentistry. J Am Dent Assoc 1982; 105: 476-481.
  • 30. Wong V, Yan T, Donald A, et al. Saliva and bloodspot cortisol: novel sampling methods to assess hydrocortisone replacement therapy in hypoadrenal patients. Clin Endocrinol (Oxf) 2004; 61: 131-137.
  • 31. Paris J. Pituitary–adrenal suppression after protracted administration of adrenal cortical hormones. Proc Staff Meet Mayo Clin 1961; 36: 305-317.
  • 32. Inder WJ, Hunt PJ. Glucocorticoid replacement in pituitary surgery: guidelines for perioperative assessment and management. J Clin Endocrinol Metab 2002; 87: 2745-2750.
  • 33. Hardy JD, Turner MD. Hydrocortisone secretion in man: studies of adrenal vein blood. Surgery 1957; 42: 194-201.
  • 34. Hume DM, Bell CC, Bartter F. Direct measurement of adrenal secretion during operative trauma and convalescence. Surgery 1962; 52: 174-187.
  • 35. Wise L, Margraf HW, Ballinger WF. A new concept on the pre- and postoperative regulation of cortisol secretion. Surgery 1972; 72: 290-299.
  • 36. Kehlet H, Binder C. Alterations in distribution volume and biological half-life of cortisol during major surgery. J Clin Endocrinol Metab 1973; 36: 330-333.
  • 37. Poulson LK. Acute adrenal insufficiency — withholding of medicines in the peri-operative period. J Pharm Pract Res 2005; 35: 311-312.
  • 38. Cooper MS, Stewart PM. Corticosteroid insufficiency in acutely ill patients. N Engl J Med 2003; 348: 727-734.
  • 39. Keh D, Boehnke T, Weber-Cartens S, et al. Immunologic and hemodynamic effects of “low-dose” hydrocortisone in septic shock: a double-blind, randomized, placebo-controlled, crossover study. Am J Respir Crit Care Med 2003; 167: 512-520.
  • 40. Ho JT, Al-Musalhi H, Chapman MJ, et al. Septic shock and sepsis: a comparison of total and free plasma cortisol levels. J Clin Endocrinol Metab 2006; 91: 105-114.
  • 41. Sam S, Corbridge TC, Mokhlesi B, et al. Cortisol levels and mortality in severe sepsis. Clin Endocrinol (Oxf) 2004; 60: 29-35.
  • 42. Monson JP. The assessment of glucocorticoid replacement therapy. Clin Endocrinol (Oxf) 1997; 46: 269-270.
  • 43. Ohman EM, Rogers S, Meenan FO, et al. Adrenal suppression following low-dose topical clobetasol propionate. J R Soc Med 1987; 80: 422-424.
  • 44. Carr BR, Parker CR Jr, Madden JD, et al. Maternal plasma adrenocorticotropin and cortisol relationships throughout human pregnancy. Am J Obstet Gynecol 1981; 139: 416-422.
  • 45. Trainer PJ. Corticosteroids and pregnancy. Semin Reprod Med 2002; 20: 375-380.


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