Preoperative preparation of the patients with adrenal cortex dysfunction is based on the careful preoperative evaluation of the type and the severity of the disturbance. The dysfunction involving adrenal glands may be: insufficiency (severe, mild, expressed) and hyperfunction (
hypercorticism and/or
hyperaldosteronism). If we speak about the patients with limited adrenal reserve (
Addison's disease, therapeutic
glucocorticoid application etc.) they need necessary
corticosteroid supplementation, during preoperative preparation, as well as, during complete
perioperative period. Doses needed for the substitution are adjusted according to the severity of
adrenal insufficiency and according to the extent of the planned
surgical procedure. Patients with
Cushing's syndrome (or other form of
hypercorticism), as well as, patients with
Conn's syndrome (or other forms of
hyperaldosteronism), do have numerous organ dysfunctions, that are significant in preoperative preparation,
anesthesia and for the outcome of the surgical treatment. Common feature for both of the above syndromes is hydroelectrolyte disbalance, with
hypokalemia, metabolic
alkalosis and
hypertension. Disturbances related to the adrenal cortex hyperfunction must be corrected preoperatively, in order to avoid complications. When we speak about
hypokalemia it must be promptly corrected even before urgent/vital
surgical procedure because it may cause severe intraoperative
cardiac arrhythmia.