As the use of prednisone to treat various medical illnesses has expanded, so has the concern for hypothalamic-pituitary-adrenal (HPA) axis suppression and subsequent adrenal insufficiency (AI). Despite the fact that most clinicians clearly recognize the potential for AI, many find the sometimes subtle presentation challenging. Furthermore, clinicians often struggle with assessing the likelihood of perioperative AI risk and with preventing it. The following module will address the perioperative management of both patients with known AI and those at risk for HPA axis suppression.