Stress-induced hypothalamic excitation also promotes the release of corticotrophin releasing hormone (CRH) and the secretion of corticotrophin (ACTH) from the anterior pituitary. In association with major surgical stress, ACTH-induced cortisol secretion from the adrenal cortex increases rapidly from baseline to maximum levels in about 4-6 hours. The magnitude and duration of the increase correlate well with the severity of tissue trauma.1-3
A search of the literature failed to uncover perioperative hyperadrenocorticism as a complication of dental-procedure-related stress. However, patients with Addison’s disease and those who have undergone treatment for Cushing’s disease are inherently unable to respond to surgical stress, and patients with Cushing syndrome have variable degree of HPA axis suppression. Yet, only four putative cases of dental-procedure-related Addisonian crises have been discovered.14
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