PJ Nicholoff Steroid Protocol
Normal basal secretion of cortisol from the adrenal gland is approximately 5-7 mg/m2/day or 8 -10 mg/day for adults. This amount increases during minor illnesses or surgery to approximately 50 mg/day (5x normal physiologic secretion). These small increases with uncomplicated surgery return to baseline in 24 hours. Procedures producing greater surgical stress, have been shown to increase cortisol responses to 75-150 mg/day (10x normal physiologic secretion), which return to baseline in about 5 days.
Corticosteroids are prescribed for multiple diagnoses to a wide variety of patients. Long term administration of corticosteroids may lead to suppression of the hypothalamicpituitary- adrenal (HPA) axis. Rapid reduction or abrupt withdrawal of corticosteroid therapy that has been prolonged or at high doses can cause secondary adrenal insufficiency (suppression of the HPA axis), and steroid withdrawal or deprivation syndrome. Recovery from suppression of the HPA axis after discontinuing corticosteroids can be prolonged (possibly 6 to 12 months) and may vary based on doses, dosing schedules and duration of corticosteroid therapy. Since there is a great deal of individual variability in susceptibility to suppression of the HPA axis after chronic use of exogenous corticosteroids, it is not possible to predict with confidence which patients will be affected. Current practice is to administer supplemental (stress) doses of corticosteroids to patients with suspected suppression of the HPA axis in the perioperative period and during acute illness to prevent acute adrenal insufficiency, or adrenal crisis.