Nebennierenrinde und Steroide: Supplementäre Therapie in der perioperativen Phase

Since the publication of two case reports that are considered to represent the first clinical demonstraction of iatrogenic adrenal insufficiency, it has been the generally accepted practice to cover steroid-treated patients undergoing surgery with glucocorticoids in the perioperative period. Both the inclusion criteria for the patients and the extent of the substitution pattern have been selected on an empirical rather than on a rational basis. Scientifiic advances over the past 50 years in the knowledge of the hypothalamic-pitutary-adrenal system's physiology and the molecular mechanism of action of its biologically active components are, for the most part, not reflected in current clinical practice and instead seem to be ingored. Clinical and experimental evidence suggest, however, that even glucocorticoid-treated patients undergoing surgery do not require maximum stress doses of hydrokortisone, which should be reserved for the broad spectrum of efficacy of glucocorticoids and their side effects, revision and modification of the historical regimen appear prudent.