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May 18, 1957


Author Affiliations

New York

From the Hospital for Special Surgery, the Margaret Caspary Research Department, Cornell University Medical College.

JAMA. 1957;164(3):261-265. doi:10.1001/jama.1957.02980030037009

• Prolonged administration of steroids often, but not always, results in adrenocortical insufficiency. It has been difficult to determine whether a patient so treated is actually devoid of adrenocortical function. Elective surgery on bones and joints in such a patient should be postponed until his adrenal status is ascertained and he has been weaned away, if necessary, from the steroid. The test used for this purpose consists in administering corticotropin and determining daily salt excretion during a period of constant salt intake; hypoadrenalism is likely to exist if the corticotropin fails to reduce the salt excretion and especially if it fails to induce eosinopenia and hypokalemia. Ten patients who had been receiving steroids (for seven years, in one instance) underwent orthopedic surgery. The above test was carried out in nine and revealed adrenal insufficiency in six. The diagnosis was borne out by the occurrence of shock in four of the patients and the effectiveness of hydrocortisone given intravenously in combating it. In cases of elective surgery the operation can be postponed for several months to permit weaning, but, when emergency surgery is required in a patient who has been receiving cortisone, increased amounts of steroid will be needed during and after the operation.