Certain patients may require glucocorticoid coverage during and after surgery.


Patients who may require corticosteroid supplementation for surgery:

(1) therapy with >= 20 mg/day prednisone for > 1 week

(2) therapy with any dose of corticosteroids for > 1 month

(3) resection of a steroid secreting (typically an adrenal) tumor

(3) resection of an ACTH-secreting tumor


How long it takes to return to normal after stopping steroid therapy was not mentioned.


The patient with a steroid-secreting tumor will have suppression of the normal adrenal tissue. It may take up to 2 years (median 15 months) to recover normal hormone responsiveness.


The patient with an ACTH-secreting tumor will lose the ACTH stimulus after resection of the tumor, so may have problems post-operatively. It is uncertain how long it takes for these patients to recover normal hormone responsiveness.


If there is any doubt of the need for steroid coverage in a patient receiving steroid therapy, then a rapid ACTH stimulation test can be performed. The patient with a steroid or ACTH secreting tumor would not benefit from the test before resection of the tumor, but the test should be considered 6 months or more after the resection to assess the return to normal steroid secretion.


To read more or access our algorithms and calculators, please log in or register.