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HPA Axis Suppression — RACP Adult Medicine MCQ

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ModerateEndocrinologyHPA Axis SuppressionRACP Adult Medicine

A 45-year-old woman on long-term prednisolone 25 mg daily for SLE requires urgent cholecystectomy. Her usual morning cortisol is suppressed. What is the appropriate perioperative glucocorticoid regimen?

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Correct answer: B — IV hydrocortisone 100 mg bolus then 50 mg 6-hourly

Patients on >10 mg prednisolone daily for >3 weeks are at risk of HPA axis suppression. For major surgery, IV hydrocortisone 100 mg at induction followed by 50 mg every 6–8 hours for 48–72 hours provides appropriate stress-dose cover. This is then tapered back to the patient's usual dose as they recover.

Reference: Association of Anaesthetists/RCP/SfE – 2020 – Perioperative Glucocorticoid Guidelines