Hypoadrenocorticism, regardless of etiology, is Addison's disease. Its treatment is the daily administration of a glucocorticoid (prednisone, 5 mg or equivalent) and a mineralocorticoid (fludrocortisone, 0.05-0.20 mg). Hyperadrenocorticism as the result of excess cortisol secretion is Cushing’s disease. Its treatment is surgical and the predictable sequela is hypoadrenocorticism. Cushing’s syndrome is associated with therapeutic administration of supraphysiological doses of glucocorticoids, which may result in transient inhibition of the HPA axis.
Patients with Addison’s disease, Cushing’s disease (s/p treatment), and Cushing’s syndrome are at risk of an Addisonian crisis and may require steroid supplementation in the amount equivalent to the anticipated surgical stress (i.e., a “stress-dose”). With low-stress procedures, such as dental procedures under local anesthesia, the daily replacement dose or the therapeutic dose of glucocorticoids is considered adequate. Corticosteroids in the top 200 drugs are discussed in Table 14.17 Key recommendations for practice are presented in Tables 15 and 16.33-36
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