Blood levels of corticosteroid-binding globulin, total cortisol and unbound cortisol in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

Roth-Isigkeit, Angela; Dibbelt, L.; Schmucker, P.

doi:10.1016/s0039-128x(00)00133-1

Cited by 25 publications

(24 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The observation of very high free serum cortisol concentrations and an increased free-to-bound ratio of cortisol in the postoperative period after cardiac surgery is qualitatively in accordance with previous investigations, where calculations were applied to estimate free cortisol concentrations (10,11). Except for one study on burn patients (9), studies addressing bioactive cortisol in severely ill patients have so far relied on calculations based on the concentrations of total serum cortisol and CBG, respectively (10 -13); these calculations, however, have not been so far validated by comparison with directly measured free serum cortisol in intensive care patients.…”

Section: Discussionsupporting

confidence: 89%

“…Low concentrations of CBG found after major surgery may be explained by several mechanisms: (i) the negative acute phase behavior of CBG with decreased synthesis in response to inflammatory mediators (31 -33), (ii) the conformational changes and active depletion of CBG (8,23,30), and (iii) the in vivo serum dilution following substantial blood loss and fluid replacement. This latter dilution effect was suggested in our and and in a previous investigation (11) by the markedly decreased concentrations of serum albumin during the postoperative period.…”

Section: Discussionsupporting

confidence: 74%

“…The algorithm described by Coolens et al (17) applied in other studies (10,12) takes into account the binding characteristics of CBG and is applicable by use of standard spreadsheet software; this calculation, however, is simplified in that the concentration of albumin and sexhormone-binding globulin (as other important cortisol-binding proteins), and competing steroids as cortisone are not incorporated. Conclusive calculation of free serum cortisol concentrations taking into account the latter variables, however, is not generally applicable, since it leads to complex equations which have to be solved by numeric procedures for which no software is commercially available (11,19,22). Interestingly, calculations that incorporate the binding characteristics of CBG and cortisol -both in a simplified form (17) and by computer simulation (22) -predict a non-linear rise in bioactive free serum cortisol with increasing total serum cortisol concentrations, even at constant CBG concentrations and within the physiological range of circadian variation of cortisol concentrations; a simple "free cortisol index" (13,21) fails to display this and should not be used.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Free Serum Cortisol during the Postoperative Acute Phase Response Determined by Equilibrium Dialysis Liquid Chromatography-Tandem Mass Spectrometry

Vogeser¹,

Groetzner²,

Küpper³

et al. 2003

Clinical Chemistry and Laboratory Medicine

View full text Add to dashboard Cite

In severely ill patients low concentrations of the corticosteroid binding globulin are typically found; the aim of this study was to quantify directly free bioactive cortisol concentrations in the sera of postoperative cardiosurgical patients. Serum samples of 12 consecutive patients undergoing aortocoronary bypass surgery taken preoperatively and on the postoperative days 1 to 4 were analyzed. Total serum cortisol was quantified using liquid chromatography-tandem mass spectrometry with an on-line sample extraction system and tri-deuterated cortisol as the internal standard, and free serum cortisol was measured after over-night equilibrium dialysis. Whereas on the first postoperative day, the median total serum cortisol concentration was approximately two-fold increased compared to preoperative samples (preoperatively, 245 nmol/l (interquartile range (IQR) 203 -293 nmol/l); first postoperative day, 512 nmol/l (IQR 410 -611 nmol/l)), median dialyzable free cortisol concentration was almost seven-fold increased (preoperatively, 14.2 nmol/l (IQR 10.9 -20.7 nmol/l); first postoperative day, 98.3 nmol/l (IQR 81.3 -134 nmol/l)). On the fourth postoperative day, median free cortisol was still significantly increased compared to baseline sampling (p < 0.05), whereas median total cortisol was not. A median of 5.7% (IQR 5.4 -7.0%) of total cortisol was found as free cortisol on the preoperative day, 21.2% (IQR 18.9 -23.5%) on the first postoperative day and 10.5% (IQR 9.8 -14.0%) on the fourth postoperative day. It is concluded that during the postoperative period the freeto-bound ratio of cortisol is highly variable and that during the acute phase response direct quantification of free bioactive cortisol concentrations seems to be biologically more appropriate than the measurement of total cortisol concentrations. Clin Chem Lab Med 2003; 41(2):146 -151

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Free Serum Cortisol during the Postoperative Acute Phase Response Determined by Equilibrium Dialysis Liquid Chromatography-Tandem Mass Spectrometry

Vogeser¹,

Groetzner²,

Küpper³

et al. 2003

Clinical Chemistry and Laboratory Medicine

View full text Add to dashboard Cite

show abstract

“…This possibly explains why our patients had a good final outcome, as in general glucocorticoid secretion would have been increased although this was not discernible in this case. Measuring albumin and CBG levels together with estimations of free cortisol in patients undergoing CABG would be useful to help clarify this hypothesis (30). Dilution of proteins, such as CBG and albumin, due to the large amount of fluids given to patients during resuscitation results in a lower level of measured total cortisol.…”

Section: Discussionmentioning

confidence: 99%

Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Debono¹,

Sheppard²,

Irving³

et al. 2011

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Patients with cortisol deficiency poorly tolerate any systemic inflammatory response syndrome (SIRS), and may die if not treated with sufficient exogenous glucocorticoids. Controversy surrounds what constitutes a 'normal' adrenal response in critical illness. This study uses conventional tests for adrenal insufficiency to investigate cortisol status in patients undergoing elective coronary artery bypass surgery, a condition frequently associated with SIRS. Design: A prospective, observational study. Methods: Thirty patients with impaired left ventricular function (ejection fraction O23% !50%) underwent basal ACTH measurement, and a short cosyntropin test (250 mg, i.v.) 1 week preoperatively, and at C4 h following induction of general anaesthesia. Preoperatively, a 30 min cortisol level post cosyntropin O550 nmol/l was taken as a normal response. Results: Prior to surgery, all patients had a normal response to cosyntropin. Postoperatively, eight patients (26.7%) did not achieve stimulated cortisol levels O550 nmol/l and the mean peak cortisol postoperatively was lower (1048 vs 730 nmol/l; P!0.001). There was a significant rise in ACTH after surgery (21 vs 184 ng/l; PZ0.007) and reduction in D-cortisol post cosyntropin (579 vs 229 nmol/l; P!0.001). There was no change in basal cortisol pre-and post-operatively (447 vs 501; PZ0.4). All patients underwent routine, uneventful postoperative recovery. Conclusion: Up to one quarter of patients with a normal cortisol status preoperatively demonstrated a raised ACTH and deficient cortisol response postoperatively. Despite these responses, all patients had uneventful outcomes. These data reinforce the need for caution when interpreting results of endocrine testing following major surgery or in the intensive care environment, and that prognostic value of these results may be of limited use.

show abstract

“…Cortisol is commonly reported both as total cortisol and free cortisol. It is known that cortisol exists in plasma in three forms, 80-90% bound with high affinity to CBG, about 10-14 % associated with albumin and about 6-10% in unbound form as free cortisol [8,9,10,12,23,26,34,39,42]and it is suggested that only the free cortisol is biological active [8,10,12,36,42].There are several techniques for measurements and calculations of free cortisol but many of them are not suitable for routine laboratory use [5,11,12,15,17,43]. In this study we used a modified model (cortisol/CBG ratio) of the Free Cortisol Index [5].In our study we found no seasonal variations in the calculated cortisol-to-CBG ratio neither in OC users nor in non-users.…”

Section: Limitations and Methodological Aspectsmentioning

confidence: 99%

Impact of Season and Oral Contraceptive use on Cortisol Levelsin Physically Active Women

Wikström-Frisén¹,

Nordström²,

Mincheva‐Nilsson³

et al. 2016

JESO

View full text Add to dashboard Cite

Open Access Research Articletraining sessions and periods, [19,30,31]and the time needed for recovery is considered to be much longer compared to OR [22]. Because of both gradual onset of OR and gradual transition from OR to OTS, it is important to detect symptoms at an early stage [30].No single, specific, and reliable biological parameter to diagnose OR and OTS at an early stage has been found, and there has been only little improvement in recent years in developing tools suitable for diagnostics [1,22,30,45]. Hence, physicians and trainers are looking for new ways to diagnose and monitor athletes that may be at risk [1,28].The resting cortisol level has been suggested to play an interesting role in detecting OR and OTS since it is thought to indicate stress [19,31]. However, levels of resting cortisol has been both increased, decreased and unchanged in over trained athletes, and the research has mainly been performed on male athletes [3,18,25,32,33,44,46].Female athletes have become a common part of the sports environment [21]and since most research has been performed on male athletes, studies on female athletes are warranted. Oral Contraceptive (OC) use is prevalent in female athletes [21,41] and the impact of OC use and non-use on cortisol levels in female athletes are not well studied. Hence the influence of both the exogenous and the endogenous hormonal profiles on athletic performance should be investigated [41]. An administration of estrogen, as in women with OC use, can cause increase in total plasma cortisol [8,10], and in free cortisol [39]. Coolens et al. [12] showed elevated cortisol levels in estrogen treated women, but unbound cortisol levels were similar to the control group. Since estrogen could influence cortisol levels, studies on female athletes should include both OC users and nonusers. Moreover, since seasonal periodicity in various endocrine functions can occur [24,37] it seems crucial to determine if this may effect cortisol levels differently in OC users and non-users. As the role of cortisol in indicating stress is multifaceted and complex there is a need to investigate both seasonal variation and impact of oral contraceptive use on cortisol levels to evaluate if cortisol could be used to diagnose and monitor female athletes that may be at risk to develop OR and OTS. AbstractWhen athletes optimize their physical performance, an imbalance could occur between the strain of training, time for recovery and the athlete's individual tolerance of stress that could lead to overreaching and overtraining syndrome. Cortisol has been suggested to be a biological, diagnostic marker to detect overreaching and overtraining syndrome, since it is thought to indicate stress. This study aimed to provide normative data on cortisol levels, hence investigate seasonality and impact of oral contraceptive use to elucidate if cortisol could be used as a diagnostic marker to detect overreaching and overtraining syndrome in female athletes. The women, divided in two groups, oral contraceptive users (n = 15) and ...

show abstract

Blood levels of corticosteroid-binding globulin, total cortisol and unbound cortisol in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

Cited by 25 publications

References 38 publications

Free Serum Cortisol during the Postoperative Acute Phase Response Determined by Equilibrium Dialysis Liquid Chromatography-Tandem Mass Spectrometry

Free Serum Cortisol during the Postoperative Acute Phase Response Determined by Equilibrium Dialysis Liquid Chromatography-Tandem Mass Spectrometry

Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Impact of Season and Oral Contraceptive use on Cortisol Levelsin Physically Active Women

Contact Info

Product

Resources

About