히드로코티손이 코티솔의 역할을 해 주고 있어 수치가 낮은 게 아닐까요? 코티솔은 생명에 중요한 호르몬이라 정말로 부족했다면 부신기능저하증 증상들이 나타났을 것 같습니다. 무증상이라는 게 히드로코티손으로 잘 대체가 되고 있는 것으로 보여요

근데 알렌 이론에서는 예방적으로도 수술 전에 하이드로코티손을 증량해준다고 되어있긴한데 이유가 좀 궁금하긴 하네요...ㅠ

ACTH DEFICIENCY The primary consequence of lack of corticotropin (ACTH) is cortisol deficiency. As a result, treatment consists of the administration of hydrocortisone in an amount and timing to mimic the normal pattern of cortisol secretion. Because there is no test to assess the adequacy of the replacement, the optimal doses are not known. Most authorities recommend replacement with hydrocortisone because that is the hormone the adrenal glands make normally (hydrocortisone and cortisol are different names for the same chemical structure). Preparation and dose — Most authorities recommend hydrocortisone doses of 15 to 25 mg/day [1,2] because those doses are similar to daily production rates [3]. Patients who are more severely deficient or weigh more tend to need doses at the upper end of this range and vice versa. Some patients, however, need even larger doses to avoid severely symptomatic adrenal insufficiency, and others can get by on smaller amounts.

Nonsuppressed HPA axis — Prednisone doses of less than 5 mg/day given in the morning do not suppress the hypothalamic-pituitary-adrenal (HPA) axis. The equivalent morning doses of other glucocorticoids (eg, 4 mg/day of methylprednisolone, 0.5 mg/day of dexamethasone, or 20 mg/day of hydrocortisone) will have a similar effect (table 1). (See "Pharmacologic use of glucocorticoids".) We suggest that the following groups of patients do not need additional perioperative glucocorticoid coverage, because they are not considered to have suppression of their HPA axis: ●Any patient who has been taking any dose of glucocorticoid for less than three weeks ●Patients who have received morning doses of less than 5 mg/day of prednisone or its equivalent for any length of time ●Patients being treated with less than 10 mg of prednisone or its equivalent every other day These patients can be safely maintained on their normal daily dose of glucocorticoids in the perioperative period

Uptodate 내용입니다. 시한증후군으로 인한 ACTH deficiency의 경우 Hydrocortisone 15~25mg/day 로 권고를 하고 있으며 하루 20mg/day hydrocortisone 이하 복용자는 복용 기간에 상관없이 수술전 추가적인 glucocorticoid coverage가 필요없다고 하는 것 같습니다... 내용은 이런 것 같은데.. 만약 이 내용이 맞다면 학생 수준에서 맞출 수 없는 문제라고 생각됩니다. 다른 풀이 방법이 있을 수도 있을 것 같습니다.

●The first step in the evaluation of the HPA axis is a morning (8 AM) serum cortisol (24-hour off glucocorticoid replacement dose). •If the 8 AM cortisol is <5 mcg/dL (138 nmol/L), the patient is likely to have a suppressed HPA axis, and we therefore suggest additional glucocorticoid intake perioperatively (table 2) (Grade 2C). •If the 8 AM cortisol is >10 mcg/dL (275 nmol/L), the patient likely does not have a significant impairment of the HPA axis, and the patient may be continued on his current glucocorticoid replacement dose on the day of surgery (Grade 2C). •If 8 AM cortisol level is between 5 to 10 mcg/dL (138 to 275 nmol/L), we suggest further evaluation with a corticotropin (ACTH) stimulation test (if time permits) or empiric additional glucocorticoid therapy (table 2) (Grade 2C).

다른 접근으로는 HPA axis가 억제되어있는건 맞지만 그렇다고 현재 hydrocortisone복용을 증량 하는게 아니라 수술 당일날에 추가투여 해주는 느낌이라 일단 당장은 경과관찰(본래 복용량 유지)하는게 맞는 것 같습니다.