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Preoperative glucocorticoid Rx major risk factor
Not seen with prednisone equivalent !5 mg/day; < 3 weeks
Etomidate suppresses 11 #-hydroxylase ~24 72 h
Hypotension or manifestations of AI very uncommon insurgical patients (as opposed to septic shock)
Doses of hydrocortisone ~50 mg IV q8h PLENTY
Maximal stress response of adrenals < 300 mg/day
High dose (250 mcg) ACTH stimulation testingunderestimates incidence of HPA axis suppression
But no demonstrably superior alternative
Cortisol assays highly variable
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