Perioperative Evaluation and Treatment of Adrenal Insufficiency

Bruce E. Johnson, MD, FACP

SUMMARY 

As the use of steroids (usually prednisone) to treat various medical illnesses has expanded, so has the concern for hypothalamic-pituitary-adrenal (HPA) axis suppression and subsequent adrenal insufficiency (AI). Despite the fact that most clinicians clearly recognize the potential for AI, many find the sometimes-subtle presentation challenging. Furthermore, clinicians often struggle with assessing the likelihood of perioperative AI risk and with preventing it. The following module will address the perioperative management of both patients with known AI and those at risk for HPA axis suppression.

TARGET AUDIENCE

This activity is designed for hospitalists.

LEARNING OBJECTIVES 

After completing this module, the participant should be able to:

  1. Recall the hypothalamic-pituitary-adrenal (HPA) axis and the function of the normal adrenal gland.
  2. Identify the symptoms of adrenal insufficiency (AI), the diseases/conditions which cause it, and the typical replacement therapy.
  3. Design a strategy to risk-stratify patients for postoperative AI complications based on history and the likely surgical stress.
  4. Formulate a plan to risk-stratify patients for postoperative AI complications based on HPA axis testing.
  5. Choose treatments to prevent postoperative AI complications in patients identified as at-risk for AI.
ACCREDITATION STATEMENT 

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT STATEMENT DESIGNATION

The Society of Hospital Medicine designates this activity for a maximum of XX AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Release Date: XX/XX/20XX
Expiration Date: XX/XX/20XX
Estimated time to complete: 2 hours

CONFLICT OF INTEREST DISCLOSURE POLICY

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

INSTRUCTIONS

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Course summary
Available credit: 
  • 0.00 AMA PRA Category 1 Credit™
  • 0.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit
  • 0.00 Non-physician
  • 0.00 ABP MOC Self Assessment Points
Course opens: 
09/17/2018
Course expires: 
09/17/2021
Member cost:
$0.00
Your cost:
$0.00
Rating: 
0
FACULTY & DISCLOSURES 

The planners and faculty for this activity have no relevant relationships to disclose.

Bruce E. Johnson, MD, FACP
Professor of Medicine
Section of General Internal Medicine
Director of Clinical Integrative Sessions
Virginia Tech Carilion School of Medicine
Roanoke, Virginia 

Leonard Feldman, MD, FACP, SFHM
Associate Professor of Medicine 
Johns Hopkins University School of Medicine 
Urban Health Residency and Track Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Founding Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland

Kurt Pfeifer, MD, FACP, SFHM
Professor of Medicine
General Internal Medicine
Medical Director, Froedtert and Medical College of Wisconsin Eye Institute Perioperative Services
Medical College of Wisconsin
Associate Editor-in-Chief, Consultative & Perioperative Medicine Essentials for Hospitalists
Milwaukee, Wisconsin

SHM CONFLICT OF INTEREST DISCLOSURE POLICY

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

ACCREDITATION STATEMENT

The Society of Hospital Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

CREDIT STATEMENT DESIGNATION 

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to XX MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Available Credit

  • 0.00 AMA PRA Category 1 Credit™
  • 0.00 ABIM MOC Self Evaluation Points
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.00 MOC points [and patient safety MOC credit] in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit
  • 0.00 Non-physician
  • 0.00 ABP MOC Self Assessment Points

Accreditation Period

Course opens: 
09/17/2018
Course expires: 
09/17/2021

Price

Member cost:
$0.00
Your cost:
$0.00
Please login or register to take this course.

The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of several sections: a pre-test, a study program, a post-test, & CME evaluation. All sections must be completed to receive CME credit.

Click START to begin.