{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:37:46Z","timestamp":1791261466160,"version":"4.1.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T00:00:00Z","timestamp":1580688000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    These guidelines aim to ensure that patients with adrenal insufficiency are identified and adequately supplemented with glucocorticoids during the peri\u2010operative period. There are two major categories of adrenal insufficiency. Primary adrenal insufficiency is due to diseases of the adrenal gland (failure of the hormone\u2010producing gland), and secondary adrenal insufficiency is due to deficient adrenocorticotropin hormone secretion by the pituitary gland, or deficient corticotropin\u2010releasing hormone secretion by the hypothalamus (failure of the regulatory centres). Patients taking physiological replacement doses of corticosteroids for either primary or secondary adrenal insufficiency are at significant risk of adrenal crisis and must be given stress doses of hydrocortisone during the peri\u2010operative period. Many more patients other than those with adrenal and hypothalamic\u2013pituitary causes of adrenal failure are receiving glucocorticoids as treatment for other medical conditions. Daily doses of prednisolone of 5\u00a0mg or greater in adults and 10\u201315\u00a0mg.m\n                    <jats:sup>\u22122<\/jats:sup>\n                    hydrocortisone equivalent or greater in children may result in hypothalamo\u2013pituitary\u2013adrenal axis suppression if administered for 1\u00a0month or more by oral, inhaled, intranasal, intra\u2010articular or topical routes; this chronic administration of glucocorticoids is the most common cause of secondary adrenal suppression, sometimes referred to as tertiary adrenal insufficiency. 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 to usual 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.\n                  <\/jats:p>","DOI":"10.1111\/anae.14963","type":"journal-article","created":{"date-parts":[[2020,2,3]],"date-time":"2020-02-03T20:25:13Z","timestamp":1580761513000},"page":"654-663","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":154,"title":["Guidelines for the management of glucocorticoids during the peri\u2010operative period for patients with adrenal insufficiency"],"prefix":"10.1111","volume":"75","author":[{"given":"T.","family":"Woodcock","sequence":"first","affiliation":[{"name":"Co\u2010Chair, Working Party on behalf of the Association of Anaesthetists Hampshire UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P.","family":"Barker","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Norfolk and Norwich University Hospital NHS Trust Norfolk UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Adult Intensive Care Unit University Hospital of Wales Cardiff Wales"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Fletcher","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Norfolk and Norwich University Hospital NHS Trust on behalf of the Royal College of Anaesthetists Norfolk UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. A. H.","family":"Wass","sequence":"additional","affiliation":[{"name":"Department of Endocrinology Oxford Centre for Diabetes, Endocrinology and Metabolism Churchill Hospital Chair Clinical Reference Group for Endocrinology, on behalf of the Royal College of Physicians Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. W.","family":"Tomlinson","sequence":"additional","affiliation":[{"name":"Oxford Centre for Diabetes, Endocrinology and Metabolism NIHR Oxford Biomedical Research Centre Churchill Hospital University of Oxford Oxford UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"U.","family":"Misra","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia Sunderland Royal Hospital Sunderland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Dattani","sequence":"additional","affiliation":[{"name":"Genetics and Genomic Medicine Programme UCL Great Ormond Street Institute of Child Health London UK"},{"name":"Consultant Paediatric Endocrinologist and Head of Clinical Service in Endocrinology Great Ormond Street Hospital for Children London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W.","family":"Arlt","sequence":"additional","affiliation":[{"name":"Institute of Metabolism and Systems Research University of 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