During bilateral adrenalectomy, intraoperative dose of hydrocoisone should be given after -

Ans. is 'd' i.e., Excision of both adrenal galnds About coicosteroids given in adrenalectomy, the maximum we could get is mentioned below. The answer has been confirmed by a good knowledgeable Prof. in Surgery. Schwaz 9/e p1397 writes? "Patients undergoing surgery for a primary adrenal adenoma secreting glucocoicoids require preoperative and postoperative steroids due to suppression of the contralateral adrenal gland. Duration of steroid therapy is determined by the ACTH stimulation test. Exogenous steroids may be needed for up to 2 years but are needed indefinitely in patients who have undergone bilateral adrenalectomy. This latter group of patients also may require mineralocoicoid replacement therapy." Sabiston 18/e p1013 writes? "Perioperative and postoperative glucocoicoid administration is obviously essential in the care of patients with Cushing's syndrome. For patients undergoing adrenalectomy for Cushing's syndrome, perioperative "stress dose" steroids (hydrocoisone, 100 mg IV every 8 hours for 24 hours) are recommended." Note that Bailey (25/e p811) & CSDT (13/e p749) differ from Schwaz and Sabiston. According to them only post operative steroids are given.