A 58-year-old man with a 6-month history of Cushing's syndrome is scheduled for elective transsphenoidal pituitary adenomectomy. He has been on oral prednisolone 5 mg daily for the past 2 years for concurrent rheumatoid arthritis. What is the MOST appropriate perioperative steroid management?

• A Continue the usual 5 mg prednisolone dose only
• B Administer usual dose plus stress-dose hydrocortisone 100 mg on induction ✓
• C Give no additional steroids since the patient is Cushingoid
• D Discontinue steroids 48 hours preoperatively

Explanation

Any patient on long-term corticosteroids for more than 3 weeks (typically >5 mg prednisolone daily for >3 weeks) develops hypothalamic-pituitary-adrenal axis suppression and requires stress-dose steroids perioperatively. The Cushingoid status does not indicate adequate adrenal reserve. Discontinuing steroids risks adrenal crisis. Hydrocortisone 100 mg intravenously on induction is standard.

Reference: Miller's Anaesthesia, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.