The Importance of Treating Adrenal Insufficiency Empirically

The most common reason for adrenal insufficiency in the United States is suppression of ACTH secretion from exogenous steroids. These are your patients that are on prednisone for whatever reason, rheumatoid arthritis or lupus. They're coming into heavy surgery and they're adrenally suppressed. You get fatigue, anorexia, abdominal pain, nausea, diarrhea, and that classic skin hyperpigmentation. The key concept there is you don't wait for your test. You treat these patients.