Postoperative care after bilateral adrenalectomy: which statement shows understanding?

• A. I will have to take mineralocorticoids daily for 2 years.
• B. I will have to take glucocorticoids and mineralocorticoids daily for 2 years.
• C. When I experience signs of stress I will have to take mineralocorticoids as needed.
• D. I will have to take glucocorticoids and mineralocorticoids daily for life.

Answer: (D)

After bilateral adrenalectomy, the body can no longer produce cortisol (glucocorticoids) or aldosterone (mineralocorticoids). Replacing both hormones is needed for life to prevent adrenal crisis, maintain metabolism, fluid and electrolyte balance, and blood pressure. Glucocorticoids are taken daily to substitute cortisol and to support the body’s stress response, while mineralocorticoids are taken daily to replace aldosterone and keep sodium and water balance stable. During illness or surgery, you’ll need a managed plan to increase glucocorticoid doses (stress dosing) to cope with the added stress, but mineralocorticoids are not taken only when stressed; they’re a daily replacement. The idea of needing mineralocorticoids only as needed during stress, or needing either hormone only for a limited time, isn’t correct. Therefore, taking both glucocorticoids and mineralocorticoids daily for life is the correct understanding.