Perioperative management of a patient with primary adrenal insufficiency who underwent general anesthesia twice

Perioperative corticosteroid supplementation is generally applied in patients with primary adrenal insufficiency or treated with long-term corticosteroid Currently, appropriate dose and timing of corticosteroid were revised. A 77-year-old woman with primary adrenal insufficiency underwent transurethral resection of bladder tumor (operation 1) and mastectomy (operation 2). In both operations, we supplied stress dose of hydrocortisone on the operative day (100 mg · day^-1 of hydrocortisone for operation 1 or 300 mg · day^-1 of hydrocortisone for operation 2) and decreased gradually in one day (operation 1) or in three days (operation 2), respectively. No remarkable symptoms of adrenal deficiency and side effects of corticosteroid during perioperative period were observed. According to current recommendation, the dose of corticosteroid we used could be smaller. Perioperative management of adrenal insufficiency is still controversial, and further investigation is necessary.