Miller C S, Little J W, Falace D A
University of Kentucky College of Dentistry, 800 Rose St., Lexington, Ky. 40536-0297, USA.
J Am Dent Assoc. 2001 Nov;132(11):1570-9; quiz 1596-7. doi: 10.14219/jada.archive.2001.0092.
Dental patients with primary or secondary adrenal insufficiency, or AI, may be at risk of experiencing adrenal crisis during or after invasive procedures. Since the mid-1950s, supplemental steroids in rather large doses have been recommended for patients with AI to prevent adrenal crisis.
To evaluate the need for supplemental steroids in these patients, the authors searched the literature from 1966 to 2000 using MEDLINE and textbooks for information that addressed AI and adrenal crisis in dentistry. Reference lists of relevant publications and review articles also were examined for information about the topic.
The review identified only four reports of purported adrenal crisis in dentistry. Factors associated with the risk of adrenal crisis included the magnitude of surgery, the use of general anesthetics, the health status and stability of the patient, and the degree of pain control.
The limited number of reported cases strongly suggests that adrenal crisis is a rare event in dentistry, especially for patients with secondary AI, and most routine dental procedures can be performed without glucocorticoid supplementation.
The authors identify risk conditions for adrenal crisis and suggest new guidelines to prevent this problem in dental patients with AI.
患有原发性或继发性肾上腺功能不全（AI）的牙科患者在侵入性操作期间或之后可能有发生肾上腺危象的风险。自20世纪50年代中期以来，一直建议为AI患者使用相当大剂量的补充类固醇以预防肾上腺危象。
为评估这些患者补充类固醇的必要性，作者使用MEDLINE检索了1966年至2000年的文献，并查阅了教科书，以获取有关牙科领域中AI和肾上腺危象的信息。还查阅了相关出版物和综述文章的参考文献列表以获取有关该主题的信息。
该综述仅发现了4例牙科领域中所谓肾上腺危象的报告。与肾上腺危象风险相关的因素包括手术规模、全身麻醉的使用、患者的健康状况和稳定性以及疼痛控制程度。
报告病例数量有限强烈表明，肾上腺危象在牙科领域是罕见事件，尤其是对于继发性AI患者，并且大多数常规牙科操作无需补充糖皮质激素即可进行。
作者确定了肾上腺危象的风险状况，并提出了预防AI牙科患者出现此问题的新指南。
