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Perioperative Adrenal Crisis 

Perioperative Adrenal Crisis
Chapter:
Perioperative Adrenal Crisis
Author(s):

Jing Tao

, and Jeffrey J. Schwartz

DOI:
10.1093/med/9780190226459.003.0028
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date: 18 February 2020

Perioperative adrenal insufficiency (AI) (adrenal crisis) is an uncommon life-threatening condition manifested by distributive shock that is poorly responsive to the administration of fluids and vasopressors. Timely treatment with high doses of glucocorticoids can be life saving. The difficulty is in recognizing the patient at risk, suspecting the diagnosis, and distinguishing it from other forms of shock. The incidence of adrenal crisis is rare, in large part, due to the liberal use of perioperative “stress dose” steroids in patients already receiving steroids. In this chapter we review the pathophysiology involved in both primary and secondary AI, and provide step-by-step treatment recommendations for patients as risk for this condition.

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