Dear all,
May someone help me with this.
For patients who have been taking a steroid medication for longer than 3 weeks and the dosage is above 10 mg per day then adrenal crisis/suppression may occur 6- 12 hours or even longer after a dental treatment (such as tooth extraction/ extended restorative treatment)
My question is what is the reason for this possible delayed progression of the adrenal suppression? for instance, why does not it happen immediately during the potentially stressful time ( during tooth extraction)
Looking forward to hearing back from you
Hello dear, according to exact steroid dose,
100 mg Hydrocortisone= 5 mg Prednisolone =20 mg Cortisol (naturally occurring) =0.75 mg Dexamethsone,
and the period of time taken to cause negative feed back to adrenal gland. so if there is low dose of steroid in serum than can cope with extraction stress so it explained the delay time as most patient can not eat post extraction.
Due to anesthesia and analgesic effect of local anesthesia with patient councelling, patient stress level decreases. There fore less steroid need to cope up with stress.
Extraction is a day time procedure and most of the patient joins their job/ due to pain/ taking extra pre caution tries to skip their meal causing hypo Na,K,Ca with starvation building stress there for can lead precipitation of adrenal crisis.
So, it's very important to tell patient to take their medicine along with meals post operatively.
When the patient is subjected to stress (dental procedure), there is an increase in the corticotropin-releasing hormone (CRH) as well as vasopressin, and it acts synergistically with the CRH. Depending on the dose and amount of circulating glucocorticoids, it will be self-regulating (negative feed-back) at the level of the hypothalamus and pituitary. Recalling that ACTH is regulated by circadian cycles (such as the wake-sleep cycle), there are cyclical variations in plasma cortisol concentrations according to the hours of the day, which is related to being reflected hours after extraction.
Another factor to consider is that basal cortisol secretion increases progressively with age, inclusive there is an association between high baseline cortisol levels and decreased specific cognitive functions. Among the effects of cortisol are: delayed healing and wound repair. or bone fractures, immunosuppression, maintains homeostasis during stress and vascular reactivity, inhibits the inflammatory and allergic response, and stimulates gene transcription for enzymes that degrade proteins, resulting in an increased rate of glycogen synthesis in the liver by neoglycogenesis, among others.
Bilateral adrenal gland bleeding. It's caused by sepsis usually G(-) bacteria infection such as meningococcal (Water house friderichsen syndrome) or kidney vein embolism caused by retroperitoneal bleeding.
Could it be that is autoimmune response that form thromboembolism at kidney because of too many antibiotics?
So if using moderate antibiotics to help p't immune system reducing the burden on before surgery, maybe can reduce this situation probability.