After a unilateral adrenalectomy, corticosteroids are tapered in the postoperative period to prevent what condition?

• A. Acute infection
• B. Cortisol deficiency
• C. Hypertension
• D. Hyperglycemia

Answer: (B)

After unilateral adrenalectomy, the concern is maintaining adequate cortisol production as the body adjusts. Removing one adrenal gland reduces the total capacity for cortisol synthesis, and if the patient has any suppression of the hypothalamic-pituitary-adrenal (HPA) axis from prior steroid use, the remaining adrenal gland may not immediately meet the body's stress and metabolic needs. Abruptly stopping corticosteroids can unmask or cause cortisol deficiency, leading to adrenal insufficiency or crisis, which can be life-threatening in the perioperative period.

Tapering the corticosteroids allows the remaining adrenal gland time to resume adequate cortisol output and helps prevent symptoms of deficiency such as weakness, nausea, vomiting, hypotension, and hypoglycemia. Perioperative management often includes giving steroids initially and then gradually reducing the dose while monitoring the patient’s hemodynamic status and symptoms.

In contrast, acute infection, hypertension, or hyperglycemia are not the primary concerns driving this tapering decision in this context; they relate to different aspects of postoperative care or steroid effects, not the immediate risk being addressed here.