Operative and postoperative emergency use of hydrocortisone derivatives and corticotropin.

Impairment of adrenal function is a great hazard to patients undergoing major operation. The most important adrenal steroids are glucocorticoids (hydrocortisone), 17-ketosteroids, mineralo-corticoids (aldosterone), and small amounts of estrogen and progesterone. Urinary output of 17-hydroxycorticoids reflects overall adrenal cortical activity. Under severe stress this output increases greatly. Adrenal replacement therapy is facilitated by the advent of more powerful and more soluble adrenal hormone derivatives. Hydrocortisone hemisuccinate sodium is the agent of choice in surgical emergencies and for management of bilateral adrenalectomy. Fatal adrenal crisis may develop during operation in patients receiving hydrocortisone for long periods of time. Hydrocortisone may be of help in unresponsive shock not due to loss of blood. The usual side effects of the corticoids can be controlled easily.