American Board of Internal Medicine (ABIM) Certification Practice Exam

When should pre-op stress dose steroids be administered?

1. For all surgical patients

2. In patients with a history of cancer

3. For patients with primary adrenal insufficiency

4. For patients undergoing minor procedures

The correct answer is: For patients with primary adrenal insufficiency

Pre-operative stress dose steroids are particularly important for patients with primary adrenal insufficiency, such as those with Addison's disease. These patients have compromised adrenal glands that cannot adequately produce cortisol, especially during physical stress, such as surgery. During surgery, the body's demand for cortisol increases due to stress, and without supplemental steroids, these patients are at risk of an adrenal crisis, which can be life-threatening. Administering stress dose steroids in this context helps to mimic the body's natural response to stress, maintaining hemodynamic stability and ensuring adequate physiological support during and after the surgical procedure. Other patient groups, such as those with a history of cancer or undergoing minor procedures, do not necessarily require increased doses of steroids since they might not have the same level of adrenal insufficiency or stress response requirements. These groups may not demonstrate the same risk for adrenal crisis and thus do not need the same pre-operative steroid coverage as individuals with primary adrenal insufficiency.