Does secondary adrenal insufficiency require supplementation prior to oral surgery procedures? An update

Adrenal insufficiency (AI) is linked to a rare medical emergency, acute AI, or adrenal crisis (AC), which can occur following stressful events, like infection or surgery. A commonly overlooked form of secondary AI occurs when individuals take exogenous glucocorticoids for extended periods of time, resulting in hypoactivity of the adrenal glands. Many patients take glucocorticoids to treat conditions like asthma, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, or dermatitis. These patients may be prone to secondary AI, which may go undetected, increasing their risk of facing a medical emergency.
Our aim is to review the literature on current guidelines for corticosteroid supplementation for patients at risk of AC; and assess the risk of developing AI in patients taking exogenous glucocorticoids and whether the current supplementation guidelines require modifications.
Current recommendations from the Addison’s disease self-help group and Miller suggest steroid supplementation for dental procedures only for patients with primary AI. However, they do not recommend supplementation for patients with secondary or tertiary adrenal insufficiency.
The drawbacks of short-term supplementation of glucocorticoids in patients at risk of secondary AI, for stressful dental procedures is negligible. Adverse effects of glucocorticoid use are typically seen after prolonged usage. Thus, steroid supplementation before dental procedures should be considered, customized based on identified risk factors and the stress associated with the procedure, as a pragmatic and preemptive approach to reduce the risk of AC. Moreover, this review highlights the need for updated guidance on supplementing patients at risk of secondary AI