Although adrenal insufficiency is a relatively rare clinical problem, failure to recognize and treat this condition frequently proves rapidly fatal. Suppression of adrenal function as a result of prior steroid use is the most common cause

TABLE 72-3 Drugs That Inhibit Adrenal Function

Antimetabolites: aminoglutethimide, metyrapone, and mitotane

Antibacteriais, antifungals: rifampin and ketoconazole Anesthetic agents: phénobarbital, etomidate Other: Phenytoin of adrenal insufficiency in the surgical patient. A careful history of steroid usage must be obtained from all patients. Adequate steroid coverage for the duration of stress is necessary in these patients as well as in other patients previously taking steroids for the established diagnosis of adrenal insufficiency. More treacherous is the development of acute adrenal insufficiency in the patient receiving anticoagulants, with a coagulopathy, suffering from a thromboembolic disease, receiving steroid-altering drugs, or with malignancy. Any stressed patient is a candidate for adrenal hemorrhage and insufficiency. Any critically ill patient, particularly septic patients, should be suspected of having adrenal insufficiency. Unanticipated hypotension and shock in any person should always raise the question of adrenal insufficiency.


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chapter 73

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