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What steroid supplementation is required for a patient with primary adrenal insufficiency undergoing a dental procedure? Simone Henderson Dental Update 2024 41:4, 707-709.
Authors
SimoneHenderson
BPharm
Medicines Information Pharmacist, North West Medicines Information Centre and National Dental Medicines Information Service, Pharmacy Practice Unit, 70 Pembroke Place, Liverpool L69 3GF, UK
Patients with primary adrenal insufficiency (Addison's disease) lack the endogenous steroid hormones cortisol and aldosterone and require daily steroid therapy (usually hydrocortisone and fludrocortisone) to replace them. These patients are unable to adapt physiologically to stress and may need supplemental steroid therapy when having dental procedures, to prevent adrenal crisis. This paper provides guidance on dental procedures for which steroid supplementation may be required in patients with primary adrenal insufficiency and gives advice on doses and timing of supplementation. It does not address the management of patients with secondary adrenal insufficiency caused by long-term use of high doses of steroids. This document is for guidance only. Patients with primary adrenal insufficiency should be assessed individually as steroid requirements will vary.
Clinical Relevance: Although patients with primary adrenal insufficiency (Addison's disease) are invariably very well informed about their steroid requirements prior to a dental procedure, dental staff should have an understanding of the steroid supplementation that may be required.
Article
Primary adrenal insufficiency (Addison's disease) is a rare disorder of the adrenal glands. It affects the production of two steroid hormones, cortisol and aldosterone, by the outer layer (the cortex) of the adrenals.1 Cortisol has glucocorticoid activity and weak mineralcorticoid activity2 and regulates extracellular fluid, helping to control the amount of fluid in the body. Lack of cortisol causes symptoms such as muscle weakness, poor concentration and low blood sugar.1 Aldosterone has mineralcorticoid activity and regulates salt and water balance, which maintains blood volume and blood pressure.1,2 Production of cortisol and aldosterone normally increases when the body experiences stress, for example, during surgery, trauma or serious infection.
The most frequent cause of Addison's disease is destructive atrophy when an over-active immune system attacks the body's own organs, in this case the adrenal glands. This accounts for around 70% of all cases and affects more women than men. In common with other autoimmune diseases, the exact reason for the atrophy is unknown. Other causes of Addison's include fungal infections, adrenal cancer and adrenal haemorrhage.1
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