Corticosteroid supplementation for adrenal insufficiency.

IN 1949, THE CLINICAL INTRODUCtion of cortisone, a purified glucocorticoid preparation, revolutionized medical care of patients with a host of diseases and provided lifesustaining physiologic replacement in patients with acute or chronic adrenal insufficiency (AI). 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. 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. 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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