Anaesthesia and disorders of the adrenal cortex.

The physiological significance of the adrenal cortex in the ability of the individual to withstand "stress" has long been recognized: Selye (1950) provided a detailed description of the role of the cortex in the responses to a variety of stresses, including surgical trauma. In the 1950's postoperative collapse in patients receiving corticosteroid therapy was attributed to adrenocortical insufficiency and there followed considerable interest in the role of the adrenocorticoids, particularly the glucocorticoids, in the responses to anaesthesia and surgery. More recently, there has been interest in the role of the mineralocorticoids, stimulated largely by research into the aetiology of hypertension. Improvement of diagnostic techniques in endocrinology has led to an increase in the number of patients presenting for surgical treatment of disorders of the adrenal cortex. Lately, attention has been directed to the significance of adrenocortical function and corticosteroid therapy in critical care. The mm of this article is to provide a brief description of the adrenocortical responses to anaesthesia and surgery and to review aspects of some of the more commonly occurring disorders of the adrenal cortex of relevance to the anaesthetist.