Steroid precautions for hypoadrenal patients undergoing surgery or other procedures

Patients with hypoadrenalism of any cause require special precautions before undergoing invasive procedures. This advice applies to patients with Addison's disease, hypopituitarism, or long term adrenal suppression and covers procedures such as endoscopy, dental work and major surgery.

General examination

A detailed and full general examination is mandatory in the initial assessment of any patient about to undergo a medical procedure. 

The patient with classical Addison's disease may have a deep tan, with buccal, scar and palmar pigmentation, and evidence of generalised weight loss. The patient with hypopituitarism or hypothyroidism may have a typical appearance of waxy, doughy skin, thinned hair, cool peripheries, and reduced conscious level. However, patients who are well established on suitable medication may have no abnormalities on examination.