These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately
supplemented with glucocorticoids during the peri-operative period. There are two major categories of adrenal
insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormoneproducing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone
secretion by the pituitary gland, or deficient corticotropin-releasing hormone secretion by the hypothalamus
(failure of the regulatory centres). A pragmatic approach to adrenal replacement during major stress is required;
considering the evidence available, blanket recommendations would not be appropriate, and it is essential for
the clinician to remember that adrenal replacement dosing following surgical stress or illness is in addition tousual steroid treatment. Patients with previously undiagnosed adrenal insufficiency sometimes present for the
first time following the stress of surgery. Anaesthetists must be familiar with the symptoms and signs of acute
adrenal insufficiency so that inadequate supplementation or undiagnosed adrenal insufficiency can be
detected and treated promptly. Delays may prove fatal.
*Table 2 was corrected after publication. Please view the correction file above.