Endocrinology

Question 1

What is the stress dose of Hydrocortisone in severe illness/major surgery?

Answer 1

100mg/m2 IV Hydrocortisone once and then 100mg/m2/24h divided q6h or in continuous infusion

Question 2

What is the stress dose of Hydrocortisone in Moderate illness, including fever >38.5, vomiting, diarrhea, severe head cold with fatigue or injury?

Answer 2

30mg/m2/day Hydrocortisone equivalent divided x 3 until symptoms resolve if able to tolerate oral OR Hydrocortisone must be given parenterally
30mg/m2/day to 50mg/m2/day Hydrocortisone divided every 6 h (IV) or 8h (IM)

Question 3

What dose of ICS should be considered a risk for adrenal suppression and for long?

Answer 3

ICS with >400mcg steroid and daily exposure x 3 months is a risk factor

Question 4

First morning cortisol levels (7:00-9:00) may have a role when evaluating the HPA axis in children who have a normal sleep-wake cycle, what level of Cortisol is acceptable to rule out adrenal suppression and what level confirms concern for adrenal suppression?

Answer 4

A first morning cortisol is only specific for diagnosis of AI when levels are <100
A first morning cortisol of 275 nmol/L has been used as a screening threshold in asymptomatic patients, between 100-275 suggests possible AS