Adrenal insufficiency is a deficiency in the secretion of steroid hormones, mainly glucocorticoids from the adrenal gland.It can be classified in primary when the alteration occurs at the level of the adrenal gland; or secondary, due to a central defect that compromises corticotropin (ACTH) or corticotropin-releasing hormone (CRH) secretion.Adrenergic suppression and compromised response to stress characteristic of patients with adrenal deficiency constitute a potentially fatal clinical condition, especially in operating rooms, where it becomes a challenge for the entire surgical team, particularly the anesthesiologist, where is essential to carry out a comprehensive pre-anesthetic assessment, creating an anesthetic plan focused on correct adrenergic substitution, which is decisive in the patient's prognosis.