Draga Jichici, MD, FRCP, FAHA Associate Clinical Professor, Department of Neurology and Critical Care Medicine, McMaster University School of Medicine, Canada
Draga Jichici, MD, FRCP, FAHA is a member of the following medical societies: American Academy of Neurology , Royal College of Physicians and Surgeons of Canada , Canadian Medical Protective Association , Canadian Medical Protective Association , Neurocritical Care Society , Canadian Critical Care Society , Canadian Critical Care Society , Canadian Neurocritical Care Society, Canadian Neurological Sciences Federation
Disclosure: Nothing to disclose.
Embolization. In this procedure, the blood supply to the tumor is closed off. This is a minimally invasive procedure where small particles are injected into the blood vessels to block them off. Sclerotherapy is a similar procedure where chemical agents are used to close off the vessels. These procedures can be very helpful in shrinking the tumor and decreasing pain. Often, however, the tumor will regrow its blood supply over time after these procedures. Embolization is also sometimes used prior to surgery to reduce the risk of heavy blood loss.
During minor illness (., flu or fever >38° C [° F]) the hydrocortisone dose should be doubled for 2 or 3 days. The inability to ingest hydrocortisone tablets warrants parenteral administration. Most patients can be educated to self administer hydrocortisone, 100 mg IM, and reduce the risk of an emergency room visit. Hydrocortisone, 75 mg/day, provides adequate glucocorticoid coverage for outpatient surgery. Parenteral hydrocortisone, 150 to 200 mg/day (in three or four divided doses), is needed for major surgery, with a rapid taper to normal replacement during the recovery. Patients taking more than 100 mg hydrocortisone/day do not need any additional mineralocorticoid replacement. All patients should wear some form of identification indicating their adrenal insufficiency status.