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CLINICIAN'S CORNER
Corticosteroid Supplementation for Adrenal Insufficiency
Douglas B. Coursin, MD;
Kenneth E. Wood, DO
JAMA. 2002;287:236-240.
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INTRODUCTION
In 1949, the clinical introduction of cortisone, a purified glucocorticoid preparation, revolutionized medical care of patients with a host of diseases and provided life-sustaining physiologic replacement in patients with acute or chronic adrenal insufficiency (AI).1-2 Case reports appeared shortly after the introduction of chronic glucocorticoid therapy describing life-threatening adrenal crises in patients with medical or surgical stresses not receiving adequate corticosteroid supplementation.3-4 Prior edicts suggesting large-dose, long-duration therapy were not tailored to either patient or procedure. Current recommendations about supplementation during major and minor illnesses or invasive procedures, rationale, and dosing schedules have changed.5-6 During preparation of this manuscript, we searched MEDLINE and several other evidence-based medicine databases, including the Cochrane Database of Systematic Reviews.
Adrenal Cortex Corticosteroid Production and Function
Glucocorticoids are life-sustaining cholesterol derivatives produced in the zona fasciculata of the adrenal cortex under the negative feedback control of both the hypothalamus and pituitary . . . [Full Text of this Article]
Adrenal Insufficiency
Rationale and Recommendations for Replacement or Supplemental Therapy
Corticosteroid Replacement and Adjunctive Therapy in the Critically Ill
Conclusion
Author Affiliations: Departments of Anesthesiology and Medicine (Dr Coursin) and Department of Medicine (Dr Wood), University of Wisconsin–Madison Medical School.
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