ata-minor-moderate-stress-hc

name	ata-minor-moderate-stress-hc
description	Suggests administering 25-75 mg hydrocortisone per 24 hours for 1-2 days in patients with adrenal insufficiency undergoing minor to moderate surgical stress. Triggers include patient undergoing minor to moderate surgery with known or suspected adrenal insufficiency.

Administer 25-75 mg hydrocortisone per 24 hours for 1-2 days for minor-moderate surgical stress

STEP 1 — Gather Information

Collect baseline hydrocortisone dose, type and expected duration of surgery, and confirm adrenal insufficiency diagnosis. If patient has adrenal insufficiency and is undergoing minor-moderate surgical stress, proceed to STEP 2; otherwise, use usual maintenance dosing.

STEP 2 — Rule In / Rule Out

Determine if stress dosing is indicated: Yes if adrenal insufficiency present and surgery classified as minor to moderate; No if no adrenal insufficiency or major surgical stress. If yes, proceed to STEP 3; if no, administer usual maintenance glucocorticoid dose.

STEP 3 — Classify or Stratify

Select hydrocortisone dose within 25-75 mg/24h based on surgical stress magnitude: 25 mg for minor stress, 50 mg for moderate stress, 75 mg for higher moderate stress. Divide into 2-3 doses daily (highest dose in morning). Plan duration of 1-2 days, then taper to maintenance.

STEP 4 — Decide

Administer the selected hydrocortisone dose in divided doses for 1-2 days, then reduce to usual maintenance dose while monitoring for signs of over- or under-replacement.

Clinical Guardrails / Mimics / Pitfalls

Avoid exceeding 75 mg/24h to prevent Cushingoid effects; do not use dexamethasone in pregnancy; monitor for hyperglycemia, fluid retention; ensure patient has emergency hydrocortisone kit if adrenal insufficiency is known; do not delay stress dosing in suspected adrenal crisis.

Concrete Clinical Example

A 50-year-old man with secondary adrenal insufficiency undergoing open hernia repair (moderate stress) receives 50 mg hydrocortisone daily (25 mg AM, 25 mg PM) for 2 days, then resumes his usual 20 mg daily dose.

Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118