Endocrinology Book


Perioperative Corticosteroid

Aka: Perioperative Corticosteroid, Stress Dose Steroid
  1. See Also
    1. Adrenal Insufficiency
  2. Protocol: Stress Dose Steroid
    1. Indication: Acute severe illness (critically ill such as Septic Shock)
      1. Serum Cortisol <15 to 34 mcg/dl
      2. Cortisol <9 after Corticotropin Stimulation Test
    2. Management
      1. Hydrocortisone
        1. Adults: 50 mg IV or IM q6 hours (or 3x the chronic dose)
        2. Children: 1 to 2 mg/kg IV every 8 hours
      2. Consider adding fludricortisone 50 mcg daily for 7 days
      3. Taper stress dosing over 10-14 days
  3. Protocol: Perioperative Corticosteroids
    1. Indications: Primary or secondary Adrenal Insufficiency
      1. Hypothalamic pituitary axis suppression with chronic Corticosteroids within 3-12 months of surgery
        1. Predisone 20 mg for at least 3 weeks or
        2. Prednisone 5 mg daily longterm
    2. Minor procedure not requiring sedation (doses for day of surgery)
      1. Hydrocortisone 25 mg IV or
      2. Methylprednisolone 5 mg IV
    3. Moderate procedure requiring sedation
      1. Initial (day of surgery)
        1. Hydrocortisone 50-75 mg IV or
        2. Methylprednisolone 10-15 mg IV
      2. Next
        1. Hydrocortisone 25 mg IV every 8 hours for 24 to 48 hours
        2. Methylprednisolone tapered over 1-2 days
    4. High Risk Surgery
      1. Initial (day of surgery)
        1. Hydrocortisone 100-150 mg IV or
        2. Methylprednisolone 20-30 mg IV
      2. Next
        1. Hydrocortisone 50 mg IV every 8 hours for 24 to 48 hours or
        2. Methylprednisolone tapered over 1-3 days
  4. References
    1. Dummer (2009) Perioperative Guidelines
    2. Fraboni (2012) Board Review Express, San Jose
    3. Coursin (2002) JAMA 287(2):236-40 [PubMed]

Preoperative hormone treatment (C1535921)

Concepts Therapeutic or Preventive Procedure (T061)
Dutch preoperatieve hormoonbehandeling
French Traitement hormonal préopératoire
Italian Trattamento ormonale preoperatorio
Portuguese Tratamento hormonal pré-operatório
Spanish Tratamiento hormonal prequirúrgico
Japanese 術前ホルモン療法, ジュツゼンホルモンリョウホウ
Czech Hormonální léčba před operací
Hungarian Preoperativ hormonkezelés
English Preoperative hormone treatment
German praeoperative Hormonbehandlung
Derived from the NIH UMLS (Unified Medical Language System)

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