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Management of Adrenocortical Insufficiency During Surgery

JAMES A. NICHOLAS, M.D.; CHARLES L. BURSTEIN, M.D.; CHARLES J. UMBERGER, Ph.D.; PHILIP D. WILSON, M.D.
AMA Arch Surg. 1955;71(5):737-742. doi:10.1001/archsurg.1955.01270170095018.
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Adrenocortical insufficiency, known to be present in patients with Addison's disease and in patients who have had bilateral adrenalectomy, may also be induced in patients who have been receiving therapy with cortisone or other corticosteroids. The possibility of death following surgical intervention in such persons has been pointed out.* This is particularly apt to occur in cases where emergencies require surgery to be performed without benefit of prior work-up and preparation.

We wish to describe our experiences in the management of three patients with adrenocortical insufficiency, each with a different problem, who required surgical intervention. We have had six patients with hypoadrenalism at the Hospital for Special Surgery in the past two years who required surgery; hence, it is by no means a rare problem. Five of the six patients had cortisone-induced cases of hypoadrenalism. All were prepared for surgery but one, and in only one who required emergency surgery

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