A patient with established primary adrenal insufficiency takes hydrocortisone 20 mg each morning and 10 mg each afternoon and is scheduled for open

Question

A patient with established primary adrenal insufficiency takes hydrocortisone 20 mg each morning and 10 mg each afternoon and is scheduled for open colectomy. Which perioperative glucocorticoid plan is appropriate?

Accepted Answer

Give intravenous hydrocortisone 100 mg at induction and 200 mg over the next 24 hours

Answer

Double baseline oral hydrocortisone before induction and continue the doubled dosing for 24 hours

Answer

Continue baseline oral hydrocortisone before induction and give intravenous rescue dosing for postoperative hypotension

Answer

Give intravenous dexamethasone 8 mg at induction and resume baseline oral hydrocortisone after surgery

Answer

Give hydrocortisone 50 mg IV at induction, then 100 mg during the first 24 hours

Adrenal insufficiency sick-day rules — USMLE Step 3 MCQ

A patient with established primary adrenal insufficiency takes hydrocortisone 20 mg each morning and 10 mg each afternoon and is scheduled for open colectomy. Which perioperative glucocorticoid plan is appropriate?