A patient on long-term prednisolone (>5 mg/day for >3 months) undergoes major surgery. The anesthesiologist administers a 'stress dose' of hydrocortisone. The underlying concern is:
- A Prednisolone depletes catecholamine stores, preventing sympathoadrenal response to hypovolemia
- B Chronic steroid use causes cardiac muscle weakness, reducing intraoperative cardiac reserve
- C HPA axis suppression from exogenous steroids impairs cortisol surge response to surgical stress, risking adrenal crisis ✓
- D Prednisolone inhibits nitric oxide synthesis, causing perioperative vasospasm and hypertension
Explanation
Chronic administration of supraphysiological doses of exogenous glucocorticoids suppresses CRH and ACTH secretion via negative feedback, causing atrophy of the adrenal cortex and loss of its capacity to mount the 5- to 10-fold cortisol surge required during physiological stress (surgery, trauma, serious illness). Under these conditions, the suppressed adrenal glands cannot generate adequate cortisol, risking Addisonian crisis (circulatory collapse, hypotension, hyponatremia). Perioperative stress-dose steroids (hydrocortisone 50–100 mg IV every 6–8 hours) are given to cover the period of maximal stress. The risk is present for up to 1 year after stopping prolonged steroid therapy.
Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.