Circadian rhythms are 24-h oscillating variations in physiology generated by the core circadian clock. There is now a wide body of evidence showing circadian regulation of the immune system. Innate immune cells contain the molecular circadian clock which drives rhythmic responses, from the magnitude of the inflammatory response to the numbers of circulating immune cells varying throughout the day. This leads to rhythmic presentation of disease clinically, for example the classic presentation of nocturnal asthma or the sudden development of pulmonary oedema from acute myocardial infarction first thing in the morning.

This chapter describes the anaesthetic management of the patient with endocrine and metabolic disease. Topics covered include diabetes mellitus, thyroid and parathyroid disease, acromegaly, adrenocortical disease, steroid therapy, Cushing’s and Conn’s syndromes, apudoma (including phaeochromocytoma) and abnormalities of sodium and potassium. For each topic, pre-operative investigation and optimisation, treatment, and anaesthetic management are described. The perioperative management of the diabetic patient is discussed in detail, including insulin and oral hypoglycaemic therapy. Perioperative steroid management is described.