Steroids

Question 1

A 45-ycar-old female patient KCO RhA on steroids . now is going for surgery

Q1. What’s steroid?

Answer 1

1. Organic compound that’s composed of 4 cycloalkane rings joined together

Question 2

Q2. Layes of adrenal cortex & what docs each layer secrete?

Answer 2

2. Zona Glu –> aldosterone, Zona fas.– > cortisol, ret–> sex hormones

Question 2

Q4. Who should be involved in surgery for this patient?

Answer 2

4. Endocrinologist

Question 3

Q5. Describe hypothalamo-pituitary-adrenal axis with hormones?

Answer 3

5. Hypothalamus will produce CRH –> ++ ant pituitary – ACTH –> ++ adrenal cortex to release cortisol and aldosterone

Question 3

Q3. What’re the actions of Aldosterone & Cortisol?

Answer 3

3. Aldosterone –> water retention/ plays a role in acid base balance. While cortisol –> many metabolic effect like increase glucose levels and has anti-inflammatory and immunosuppressive effect and stimulate pt synthesis in liver.

Question 4

Q6. In Pituitary hypoplasia which hormone is affected?

Answer 4

6. ACTH

Question 5

Q7. Adrenal Insufficiency which hormone is affected?

Answer 5

7. Cortisol and aldosterone

Question 6

Q8. How to optimize patient taking steroids pre-op?

Answer 6

8. According to pt dose , if he’s taking < 5 mg – nothing, > 5 mg will give 100 mg IV of hydrocortisone , 200 mg IV infusion over 24hr.

Question 6

Q9. How to educate patient starting steroids?

Answer 6

9. Not stop it suddenly/ always make doctors aware of taking steroids / ↑ possibility of infection and delayed wound healing/ may lead to osteoporosis, wt gain and increased blood sugar, ms weakness and also peptic ulcers.

Question 7

Q10. Complications of steroids?

Answer 7

10. Wt gain / DM / HTN/ peptic ulcers / prone to infection/ adisonian crisis if stopped suddenly.

Question 8

Q11. What are your concerns?

Answer 8

11. Addison’s crisis, infection and delayed wound healing and immunosuppression.

Question 9

Q12: What are the Anesthetic concerns?

Answer 9

12. Addison’s crisis and HTN / DM /chest infection and electrolyte disturbances.

Question 10

Q13.What do you know about Addisonian crisis?

Answer 10

13. Acute reduction of circulating steroids and chch by presence of abd pain, nausea vomiting and unexplained shock.

Question 11

Q14. Are all patients need to be optimizcd pre-op?

Answer 11

14. Depends on dose and duration of taking steroids

Question 12

15. 2 specific S/E of Steroids in this pt ?

Answer 12

Delayed wound healing and immunosupprsion