ADRENOCORTICAL FUNCTION AND CLINICAL COURSE DURING AND AFTER SURGERY IN UNSUPPLEMENTED GLUCOCORTICOID-TREATED PATIENTS

Abstract

Adrcnocortical function, as expressed by repeated plasma corticosteroid measurements and the clinical course, were studied in 104 glucocorticoid-treated patients undergoing surgery without supplementary glucocorticoid administration. Eight patients developed otherwise unaccountable hypotension during surgery but only 1 patient showed concomitant low plasma corticosteroid values. Eighteen patients had minimal adrenocortical function without accompanying signs of adrenocortical insufficiency. Postoperatively, 4 patients developed hypotension, which could not be correlated to cortisol deficiency. It is concluded that cortisol is not the prime determinant of blood pressure during and after surgery in glucocorticoid-treated patients, that stress-induced acute adrenocortical insufficiency must be infrequent in these patients, and that an absence of an adrenocortical response to minor surgery cannot be taken as the sole indication of pathological adrenocortical function.