A patient with known adrenocortical insufficiency is undergoing elective cholecystectomy under general anaesthesia. His usual maintenance dose is hydrocortisone 20 mg morning and 10 mg afternoon. What is the recommended perioperative steroid coverage for this major surgical stress?
- A Continue usual dose only
- B Dexamethasone 8 mg IV once
- C Hydrocortisone 100 mg IV at induction, then 50 mg every 8 hours for 24–48 hours ✓
- D Double the oral dose for 2 days post-op
Correct answer: C. Hydrocortisone 100 mg IV at induction, then 50 mg every 8 hours for 24–48 hours
Explanation
Patients with primary or secondary adrenal insufficiency require stress-dose glucocorticoid coverage for major surgery to prevent adrenal crisis. The standard approach is hydrocortisone 100 mg IV at induction followed by 50 mg IV every 8 hours for 24–48 hours, then tapering back to maintenance over 1–2 days. Dexamethasone lacks mineralocorticoid activity and is not ideal. Simply doubling oral doses is inadequate for the peri-operative stress response.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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