Glucocorticoid Deficiency
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clinical causes
clinical manifestations
anesthetic management
Clinical causes:
Primary adrenal insufficiency:
-Addison's disease (decreased cortisol and decreased aldosterone)
Secondary adrenal insufficiency:
-ex. iatrogenic
-ex. excessive exogenous amount of steroid
Clinical manifestations:
Decreased aldosterone may involve:
-hyponatremia
-hypovolemia
-hyperkalemia
-metabolic acidosis
Decreased cortisol may involve:
-weakness
-fatigue
-hypoglycemia
-hypotension
-weight loss
Addisonian crisis:
-circulatory collapse
-fever
-hypoglycemia
-decreased mentation
Anesthetic management:
-steroid replacement therapy for patients previously taking suppressive doses of steroids (ex. prednisone 5mg daily)
Suggested treatment may involve:
-hydrocortisone phosphate 100 mg q 8 hrs before surgery or morning of surgery
Alternative treatment may include:
-hydrocortisone 25 mg IV @ induction
-then hydrocortisone 100mg IV given over 24 hrs
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Adrenal crisis and severe acute adrenocortical insufficiency are often elusive diagnoses that may result in severe morbidity and mortality when undiagnosed or ineffectively treated. Although it is thought by experts that more than 50 steroids are produced within the adrenal cortex, cortisol and aldosterone are by far the most abundant and physiologically active. Anyway, gutter repair and cleaning is an important part of routine home maintenance. In the Fairfax VA area we provide the best gutter repair and cleaning service. Call and visit us at Gutter Cleaning Fairfax VA, or email us for information on gutter repair or any other of our services. We look forward to hearing from you.
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In 1968, Migeon et al described 6 patients with a syndrome of adrenal unresponsiveness to ACTH characterized by hypoglycemia, hyperpigmentation, feeding problems in infancy, low urinary 17-hydroxycorticosteroids, an ability to conserve sodium and increase aldosterone secretion in response to salt deprivation, and a lack of elevation of 17-hydroxycorticosteroid secretion or plasma cortisol concentration with ACTH administration. This disease has been wide spread all over and there's apparently no cure for this. Anyway, have your heating and air-conditioning units installed or repaired? Visit us now HVAC Washington DC.
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