This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Miscellaneous (Parathyroid & Adrenal Glands), Subject name: Surgery
During bilateral adrenalectomy for Cushing's disease, intraoperative dose of hydrocortisone should be given after : 
Select and explain. 
A. On opening the abdomen, B. Ligation of left adrenal vein, C. Ligation of right adrenal vein, D. Excision of both adrenal glands
D: Excision of both adrenal glands
Answer: D: Excision of both adrenal glands 
Explanation: Ans. is 'd' i.e., Excision of both adrenal glands About corticosteroids given in adrenalectomy, the maximum we could get is mentioned below. The answer has been confirmed by a good knowledgeable Prof, in Surgery.Schwartz 9th/e pl397 writes- "Patients undergoing surgery for a primary adrenal adenoma secreting glucocorticoids require preoperative and postoperative steroids due to suppression of the contralateral adrenal gland. Duration of steroid therapy is determined by the ACTH stimulation test. Exogenous steroids may be needed for up to 2 years but are needed indefinitely in patients who have undergone bilateral adrenalectomy. This latter group of patients also may require mineralocorticoid replacement therapy. "Sabiston 18/e pl013 writes- "Perioperative and postoperative glucocorticoid administration is obviously essential in the care of patients with Cushing's syndrome. For patients undergoing adrenalectomy for Cushing's syndrome, perioperative "stress dose" steroids (hydrocortisone, 100 mg IV every 8 hours for 24 hours) are recommended. "Note that Bailey (25th/e p811) & CSDT (13th/e p749) differ from Schwartz and Sabiston. According to them only post-operative steroids are given.