Zoekvraag 27 maart 2012 M. Sjauw Koen Fa

P: patienten die > 3 weken: ≥ 5mg prednison(equivalent) gebruiken en een operatie ondergaan I: wel stress dosis C: geen stress dosis O: postoperatieve complicaties: addison’s crisis

TABLE Therapeutic Use of Corticosteroids Endocrine: Replacement therapy (Addison's disease, pituitary disease, congenital adrenal hyperplasia), Graves' ophthalmopathy Skin: Dermatitis, pemphigus Hematology: Leukemia, lymphoma, hemolytic anemia, idiopathic thrombocytopenic purpura Gastrointestinal: Inflammatory bowel disease (ulcerative colitis, Crohn's disease) Liver: Chronic active hepatitis, transplantation, organ rejection Renal: Nephrotic syndrome, vasculitides, transplantation, rejection Central nervous system: Cerebral edema, raised intracranial pressure Respiratory: Angioedema, anaphylaxis, asthma, sarcoidosis, tuberculosis, obstructive airway disease Rheumatology: Systemic lupus erythematosus, polyarteritis, temporal arteritis, rheumatoid arthritis Muscle: Polymyalgia rheumatica, myasthenia gravis Williams Textbook of endocrinology 12 th edition

Steroid stress schema Aan wie? Bewezen of mogelijke bijnierschorsinsufficientie Wanneer? o peratie(klein/groot), addison’s crisis, bevalling, milde ziekte, psychische stress, ernstige ziekte (IC opname ) Hoe veel? Hoe lang?

TABLE Treatment of Chronic Primary Adrenal Insufficiency in Adults Steroid Coverage for Illness or Surgery in Hospital For major surgery, - give hydrocortisone 100 mg IV just before induction of anesthesia and continue q8h for first 24 hr. - Taper dose rapidly, decreasing by half per day, to maintenance level Williams textbook of endocrinology 12 th edition

Corticosteroid coverage for surgery in patients taking exogenous corticosteroids For major surgical stress (eg, esophagogastrectomy, total proctocolectomy) - take usual am steroid dose. - give 100mg of intravenous hydrocortisone before induction of anesthesia, - and 50mg every 8 hours for 24 hours. - Taper dose by half per day to maintenance level. Up to date 2012

Table Steroid Therapy Schedule for a Patient with Adrenal Insufficiency Undergoing Surgery a Hydrocortisone Infusion, Continuous mg/h Day of operation 10 Day 1 5–7.5 Day 2 2.5–5 Day 3 2.5–5 or mg orally Day 4 2.5–5 or Day Day Day Harrinson’s Principles of internal medicine17 th edition