When the body experiences acute stress (e.g. illness, trauma, surgery), the steroid demand increases.

Patients on long term steroids cannot respond to this demand because their adrenal function is suppressed.

Therefore, patients who are on long term steroids usually need more steroids than usual during periods of physiological stress e.g. surgery or acute illness

Management

Peri-operative management is as follows:

1. Switch oral steroids to 50-100mg IV hydrocortisone.
2. If there is associated hypotension then fludrocortisone can be added.
3. For minor operations oral prednisolone can be restarted immediately post-operatively. If the surgery is major then they may require IV hydrocortisone for up to 72 hours post-op.