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Adrenal Insufficiency Dental Management — MFDS Part 1 MCQ

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ModeratePharmacologyAdrenal Insufficiency Dental ManagementMFDS Part 1

A 54-year-old patient takes prednisolone 7.5 mg once daily and has done so for 3 months. A dental extraction under local anaesthesia is planned. The patient has no written peri-procedural steroid plan. Which is the most appropriate management?

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Correct answer: B — Continue the usual corticosteroid and confirm an appropriate peri-procedural glucocorticoid plan with the prescribing clinician or endocrine team

The correct answer is B. Prednisolone 7.5 mg daily for 3 months exceeds a physiological equivalent dose and may suppress the hypothalamic–pituitary–adrenal axis. Dental extraction is an invasive procedure, so the usual corticosteroid should be continued and appropriate peri-procedural glucocorticoid cover planned. Because no established plan is available, the regimen should be confirmed with the prescribing clinician or endocrine team rather than improvised. Simply doubling the dose without checking may provide inappropriate timing or cover. Abrupt cessation can precipitate adrenal insufficiency and must be avoided. Routine intramuscular dexamethasone is not indicated for every extraction, while proceeding without considering steroid cover exposes an at-risk patient to preventable adrenal crisis.

Reference: National Institute for Health and Care Excellence. NG243: Adrenal insufficiency—identification and management, sections 1.2.3, 1.4.8 and Terms used in this guideline. 2024. https://www.nice.org.uk/guidance/NG243/chapter/recommendations