Login

Member Login

Join

OpenAnesthesia

International Anesthesia Research Society

  • ABA Keywords
    • ITE Keywords
    • MOCA Keywords
  • Expert Voices
    • Article of the Month
    • Ask the Expert
    • Keys to the Cart
    • OA/SPA Pediatric Anesthesia Virtual Grand Rounds
    • Virtual Obstetric Grand Rounds
    • SOAP Obstetric Anesthesia Podcast
    • OA/SPA Ask the Expert Podcast
  • TEE Forum
    • TEE Rounds
    • Basic Course in TEE
  • Subspecialty
    • Cardiac Anesthesia
    • Critical Care and Perioperative Medicine
    • Global Health
    • Neuroanesthesia
    • Obstetric Anesthesia
    • Pain Medicine
    • Pediatric Anesthesia
    • Regional Anesthesia
  • Encyclopedia
  • Our Apps
    • SelfStudyPLUS
    • SelfStudyQbank
    • Nurse Anesthesia
  • Join SelfStudyPLUS
For the most updated list of ABA Keywords and definitions go to https://selfstudyplus.openanesthesia.org/kw
Home / ABA Keyword Categories / A / Addison’s disease: Perioperative treatment

Addison’s disease: Perioperative treatment

Definition

Addison’s disease (a primary adrenal insufficiency) is the loss or degradation of the adrenal cortex resulting in glucocorticoid and mineralocorticoid deficiency. Signs and symptoms include weakness, weight loss, joint pain, postural hypotension, headache, anorexia, constipation, diarrhea, hyperpigmentation, hyponatremia, hyperkalemia, hypoglycemia, and hypercalcemia. The most common culprit in the United States is an autoimmune process, but tuberculosis is the most common cause worldwide. Other causes include sarcoidosis, histoplasmosis, amyloidosis, metastatic malignancy, and adrenal hemorrhage.

The stress of surgery in the setting of a patient with Addison’s disease can precipitate an “Addisonian crisis” or “adrenal crisis.” This is similar to patients that have been on chronic steroid replacement therapy for a long time and stop taking their glucocorticoid. Signs and symptoms include low blood pressure, nausea and vomiting, syncope, hypoglycemia, hyponatremia, hyperkalemia, a metabolic acidosis, lethergy, confusion, and convulsions.

Preparation of such a patient for surgery should include treatment of hypovolemia, hyperkalemia, and hyponatremia. It is also recommended to give a stress dose of glucocorticoids (current literature suggests 100 mg of hydrocortisone phosphate IV every 24 hours is adequate). Note that this is less than the 200-300 mg historically recommended.

Treatment of Primary Adrenal Insufficiency

  • Pharmacologic: hydrocortisone 100 mg IV q24h
  • Physiologic: treatment of hypovolemia, hyperkalemia, and hyponatremia

Subspecialty

Related Media

Keyword history

70%/2010

See Also:

Sources

  1. Miller, RD et al. Miller’s Anesthesia, 7th edition, Churchill Livingstone: p 1081. 2009

PubMed

Filed Under: A, Clinical - Endocrine/Metabolic

IARS - International Anesthesia Research Society logo

  • Contact Us
  • About Us
  • Privacy Policy

Connect with Us

Facebook   Twitter   LinkedIn   iTunes  

OpenAnesthesia™ content is intended for educational purposes only and not intended as medical advice.

Reuse of OpenAnesthesia™ content for commercial purposes of any kind is prohibited.

Copyright © 2019