Annals Consult Guys - Perioperative Management of Patients Receiving Glucocorticoids
Authors: Geno J. Merli, Howard H. Weitz
Journal: Annals of Internal Medicine (2021)

Web ExclusivesFebruary 2021Annals Consult Guys - Perioperative Management of Patients Receiving GlucocorticoidsFREEGeno J. Merli, MD, Howard H. Weitz, MDGeno J. Merli, MDThomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Search for more papers by this author, Howard H. Weitz, MDThomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Search for more papers by this authorAuthor, Article and Disclosure Informationhttps://doi.org/10.7326/W20-0018 CME/MOC SectionsSupplemental MaterialAboutVisual Abstract ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The Consult Guys discuss the perioperative management of patients receiving long-term glucocorticoid therapy with special guest Dr. Serge Jabbour.For more videos from and information on Annals Consult Guys, visit go.annals.org/ConsultGuys. Comments0 CommentsSign In to Submit A Comment The Consult GuysJefferson University13 May 2021 Author's response The Consult Guys reached out to Dr. Serge Jabbour who was their expert for this segment and this is his response: “Completely agree; in acutely ill patients (not the surgical case we discussed), for example, a patient who is hypotensive, in the intensive care unit, suspected of having adrenal insufficiency, should have a random cortisol drawn then IV glucocorticoids started immediately until the results are back. Depending on what the cortisol level is, decision is made to either stop or continue the glucocorticoids.” Disclosures: none Michael E DorneyUSN23 April 2021 Pre-op management Gentlemen, may I suggest this management in the case of an acutely ill patient and the question of adrenal suppression: Check a stat random cortisol to answer your question. Then, administer the Hydrocortisone IV waiting for the results. Continue if the lab result is low or normal (if it's "normal" in this setting, it's LOW). If appropriately elevated, there is no adrenal suppression, but keep an eye on the patient post-op for signs of possible decline as the adrenal "reserve" is depleted. Peter H Cooke, MDNone15 March 2021 Listen to and look at the patient While the expected risk is low in this patient, between 3 and 9% there is still a risk for adrenal axis suppression. If perioperative steroids are not given you should still make a point of asking the patient if they are having any lightheadedness or weakness that is new to them. Do they feel faint sitting up to eat or to be examined? Are they too weak and lightheaded to walk to the bathroom or participate in therapy? If so and there is no other obvious explanations a maintenance dose of hydrocortisone should be considered. Disclosures: None Robin TrotmanCoxHealth15 February 2021 Protease Inhibitor and fluticasone Make sure to look out for certain hiv protease inhibitors with fluticasone and iatrogenic Cushing and resultant AI after surgery Author, Article and Disclosure InformationAffiliations: Thomas Jefferson University, Philadelphia, Pennsylvania (G.J.M., H.H.W.)Disclosures: Geno J. Merli, MD, and Howard H. Weitz, MD, report that they have no financial relationships or interests to disclose.Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Stephanie Chang, MD, MPH, Deputy Editor, reports employment with the Agency for Healthcare Research and Quality, travel compensation from the Guidelines International Network, and participation in the Patient-Centered Outcomes Research Institute methodology committee. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interests to disclose. Eliseo Guallar, MD, MPH, DrPH, Deputy Editor, Statistics, reports that he has no financial relationships or interests to disclose. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics February 2021Volume 174, Issue 2Page: CG1 ePublished: 16 February 2021 Issue Published: February 2021 CopyrightCopyright © 2021 by American College of Physicians. All Rights Reserved.Loading ...