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The use of high-dose methylprednisolone in acute spinal cord injuries remains controversial. This article is the second of a 2-part series presenting the conflicting viewpoints of today's practitioners. Part 1 of this series appeared in the April 2010 issue. [ABSTRACT FROM AUTHOR]

The use of high-dose methylprednisolone in acute spinal cord injuries remains controversial. This article is the first of a 2-part series presenting the conflicting viewpoints of today's practitioners. Please see next month's article presenting the opposing side of the argument. [ABSTRACT FROM AUTHOR]

Introduction: Relative adrenal insufficiency has been shown to occur in the settings of critical illness and septic shock, impairing the body's ability to respond to stress. Studies have demonstrated that the treatment of adrenal insufficiency (AI) results in shock reversal, hemodynamic stability, and a subsequent decrease in mortality. Endocrine changes and AI have been reported in patients with spinal cord injuries during their extended courses of rehabilitation.Discussion: We describe two cases of patients with cervical spine injuries who presented with acute adrenal insufficiency following their injuries. With the addition of low-dose corticosteroids, each patient had symptom resolution and demonstrated clinical improvement.Conclusion: Patients with spinal cord injuries are at risk for AI, both in the acute and chronic settings following injury prompting the need for an increased awareness of this condition. Although variability exists in the exact criteria for the diagnosis of AI, the combination of clinical symptoms, depressed serum cortisol concentrations, and responsiveness to exogenous steroid therapy should all contribute to the diagnosis of this condition. [ABSTRACT FROM AUTHOR]

Postoperative hypertension is a serious complication following surgery that can result in significant complications if left untreated. [ABSTRACT FROM AUTHOR]