In 1949, the clinical introduction of cortisone, a purified glucocorticoid
preparation, revolutionized medical care of patients with a host of diseases
and provided life-sustaining physiologic replacement in patients with acute
or chronic adrenal insufficiency (AI).1,2
Case reports appeared shortly after the introduction of chronic glucocorticoid
therapy describing life-threatening adrenal crises in patients with medical
or surgical stresses not receiving adequate corticosteroid supplementation.3,4 Prior edicts suggesting large-dose,
long-duration therapy were not tailored to either patient or procedure. Current
recommendations about supplementation during major and minor illnesses or
invasive procedures, rationale, and dosing schedules have changed.5,6 During preparation of this manuscript,
we searched MEDLINE and several other evidence-based medicine databases, including
the Cochrane Database of Systematic Reviews.
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