Evaluation of adrenal function in the perioperative period

Although postoperative adrenal insufficiency is a rare event, missing the diagnosis can be fatal. Its signs and symptoms are easily confused with other perioperative processes, which renders subjective diagnosis difficult. Unfortunately, the normal serum cortisol response to an operation or to the administration of synthetic adrenocorticotrophic hormone (ACTH, Cortrosyn stimulation test) in the postoperative period is unknown. Therefore, when the surgeon is confronted with a postoperative patient in extremis, the diagnosis of acute adrenal insufficiency, if considered, is one of exclusion. The clinical response to empirical hydrocortisone therapy has become the standard for diagnosis. Unnecessary replacement of adrenocorticoids is often continued well into the recovery period until formal adrenal testing can be done.