Which patient history indicates the need for perioperative glucocorticoid supplementation?

Which patient history indicates the need for perioperative glucocorticoid supplementation?

• A. Those who received more than 20 mg/d for 5 days.
• B. Patients with no prior glucocorticoid exposure require supplementation.
• C. Perioperative glucocorticoids are never needed.
• D. May have suppression for 6-12 months.

Answer: (A)

During surgery the body’s demand for cortisol rises, so if the adrenal system has been suppressed by prior systemic glucocorticoids, the patient may not produce enough cortisol on its own. A history of significant exogenous steroid exposure signals this risk and indicates the need for perioperative glucocorticoid supplementation to prevent an adrenal crisis. Exceeding 20 mg/day of prednisone (or equivalent) for several days is a common threshold used to flag suppression risk, so this history best guides giving a stress dose around the operation. In contrast, having no prior glucocorticoid exposure typically means the adrenal axis is intact and supplementation isn’t required; claiming glucocorticoids are never needed is incorrect; and while suppression can occur, stating it as a fixed 6–12 months duration isn’t the direct, practical history that triggers perioperative steroids.

During surgery the body’s demand for cortisol rises, so if the adrenal system has been suppressed by prior systemic glucocorticoids, the patient may not produce enough cortisol on its own. A history of significant exogenous steroid exposure signals this risk and indicates the need for perioperative glucocorticoid supplementation to prevent an adrenal crisis.

Exceeding 20 mg/day of prednisone (or equivalent) for several days is a common threshold used to flag suppression risk, so this history best guides giving a stress dose around the operation. In contrast, having no prior glucocorticoid exposure typically means the adrenal axis is intact and supplementation isn’t required; claiming glucocorticoids are never needed is incorrect; and while suppression can occur, stating it as a fixed 6–12 months duration isn’t the direct, practical history that triggers perioperative steroids.