Schiff Robert L, Welsh Gail A
General Medical Consult Service, Loyola University Medical Center, Maywood, IL, USA.
Med Clin North Am. 2003 Jan;87(1):175-92. doi: 10.1016/s0025-7125(02)00150-5.
Whenever possible, endocrine disorders should be identified and evaluated prior to surgery. A plan for perioperative management of diabetes should be based on the type of diabetes, what diabetes medications are taken, the status of diabetes control, and what type of surgery is planned. Perioperative management of diabetes must include bedside glucose monitoring. Patients with mild hypothyroidism can safely proceed with elective surgery. Elective surgery should be postponed for patients with moderate or severe hypothyroidism. Patients who have mild hyperthyroidism can undergo elective surgery with preoperative beta blockade. Elective surgery should not be done on patients with moderate or severe hyperthyroidism until they are euthyroid. Patients with pheochromocytoma need to be identified and properly treated before surgery to prevent perioperative cardiovascular complications. Patients who take endogenous steroids should have the status of their HPA axis determined prior to surgery. If the patient is undergoing moderate or major surgical stress and has documented or presumed HPA suppression, then stress doses of steroids should be give perioperatively.
只要有可能，应在手术前识别和评估内分泌紊乱。糖尿病围手术期管理计划应基于糖尿病类型、所服用的糖尿病药物、糖尿病控制状况以及计划进行的手术类型。糖尿病围手术期管理必须包括床边血糖监测。轻度甲状腺功能减退患者可安全地进行择期手术。中度或重度甲状腺功能减退患者应推迟择期手术。轻度甲状腺功能亢进患者可在术前使用β受体阻滞剂的情况下进行择期手术。中度或重度甲状腺功能亢进患者在甲状腺功能正常之前不应进行择期手术。嗜铬细胞瘤患者在手术前需要被识别并得到适当治疗，以预防围手术期心血管并发症。服用内源性类固醇的患者应在手术前确定其下丘脑-垂体-肾上腺（HPA）轴的状态。如果患者正在接受中度或大手术应激且有记录或推测的HPA轴抑制，那么应在围手术期给予应激剂量的类固醇。
