菜单
Recommends administering stress-dose glucocorticoids before surgery and tapering after surgery in patients with adrenal insufficiency before repeat testing. Triggers include preoperative planning for surgery in a patient with known or suspected adrenal insufficiency.
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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
| name | ata-preop-stress-dosing |
| description | Recommends administering stress-dose glucocorticoids before surgery and tapering after surgery in patients with adrenal insufficiency before repeat testing. Triggers include preoperative planning for surgery in a patient with known or suspected adrenal insufficiency. |
Confirm adrenal insufficiency diagnosis, review current glucocorticoid regimen, determine planned procedure and expected surgical stress (minor/moderate vs major), assess for acute illness or comorbidities. Ends with: Determine surgical stress category.
Is the surgery classified as minor/moderate stress? If yes, proceed to Step 3A; if no (major stress), proceed to Step 3B. Ends with: Branch to appropriate stress-level pathway.
3A (Minor/Moderate Stress): Select hydrocortisone 25–75 mg per 24 hours in divided doses (e.g., 25 mg PO q8h or 50 mg IV q12h).
3B (Major Stress): Select hydrocortisone 100 mg IV bolus followed by continuous infusion of 200 mg per 24 hours (alternatively 50 mg IV q6h).
Ends with: Choose specific stress-dose glucocorticoid regimen.
Administer the selected stress dose perioperatively; after surgery, taper to the patient’s maintenance glucocorticoid dose over 24–48 hours for minor/moderate stress or over 48–72 hours for major stress, then repeat HPA axis testing if clinically indicated. Ends with: Initiate stress-dose glucocorticoids and plan taper.
Do not use fludrocortisone in secondary AI; avoid dexamethasone in pregnancy; monitor for hyperglycemia, infection, and fluid overload; ensure patient carries an emergency hydrocortisone card/kit; do not taper below maintenance dose before confirming HPA recovery; avoid abrupt discontinuation of steroids.
A 45‑year‑old woman with known secondary AI undergoing elective hernia repair (minor stress) receives hydrocortisone 50 mg IV at anesthesia induction, then 25 mg PO q8h for 24 hours, then is tapered to her usual 20 mg AM/10 mg PM over the next day, with an emergency hydrocortisone kit prescribed.
Source: Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2118