Severe hypotension characterises the acute adrenocortical insufficiency of Addison's disease, and hypotension may also occur following surgery or trauma in chronic takers of steroids who do not receive supplementation, presumably as a result of suppression of the adrenals' ability to mount a stress response. This has led to the recommendation that all patients on steroid therapy should receive supplementation perioperatively; however, the population at risk is uncertain, although most authorities would include all those with more than a week's steroid therapy within the last 3-6 months. The dosage prescribed is often chosen in a heavy-handed and non-scientific manner. If too much steroid is given, there is at least a theoretical risk of increased susceptibility to infection; in addition, many patients dislike taking increased doses because depression and other mood changes may be apparent even after a short time, although other side effects typically take longer to occur. Finally, the amount of steroid reaching the neonate through breast milk should be kept to a minimum, even though small.
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