Adrenal Suppression and Steroid Supplementation in Renal Transplant Recipients

Corticosteroid Therapy in Severe Illness

“…9 In several recent studies of corticosteroid-treated patients undergoing surgery while receiving their previous doses, no patient had any intraoperative or postoperative hypotension or other problems of any kind. [86][87][88] Studies in adrenalectomized monkeys also support the concept that a replacement dose of hydrocortisone is enough to maintain normal cardiac contractility and vascular tone during the stress of a short, uncomplicated surgical procedure. 18 However, the doses of hydrocortisone given to these monkeys during surgery might have been rather high (32 mg [88 mmol] per square meter per day).…”

“…89 These results have led to the suggestion that for elective surgery and most acute illnesses, continuation of the current dose of corticosteroids suffices to maintain cardiovascular function. [86][87][88] However, if the operation or acute illness is complicated or prolonged, especially in the presence of the factors listed in Table 1, higher doses of corticosteroids should be administered, by doubling or tripling the current oral dose or by giving hydrocortisone intravenously at a dose of 100 to 150 mg daily.…”

Steroid cover for dental patients on long-term steroid medication: proposed clinical guidelines based upon a critical review of the literature

“…22 The existence of adrenal suppression can be tested by measuring the cortisol response to ACTH or insulin. 23 Bromberg et al 24 evaluated 60 transplant patients at the time of admission for surgery or for serious medical conditions. The patients had all been taking 5 to 10 mg prednisolone for longer than 3 months and had received no additional steroids.…”

Peri‐operative steroid supplementation

“…Most of the concerns expressed relate to the fear of under-diagnosing adrenal insufficiency, although Bromberg has argued the opposite -that the SST is an over-sensitive laboratory investigation that is not mirrored by any clinical deficit [11]. Clayton has suggested that by taking a 30-min cortisol value > 600 nmol.l ¹1 as a pass in the SST, the sensitivity of the test could be increased, the number of false positive 'pass' results reduced to 3.5% and the number of ITTs undertaken reduced by 25% [67].…”

“…Further clinical support for the need for only baseline steroid therapy was provided by Bromberg and colleagues in 1991 [11]. They studied renal transplant patients receiving immunosuppressive doses of glucocorticoids, who were admitted with sepsis or metabolic abnormalities, or who were undergoing surgery.…”