Influence of Age on the Endocrine-Metabolic Response to Surgery

Abstract

The pathogenesis of the increased operative risk in elderly patients is unknown. From a theoretical point of view, a change in endocrine-metabolic response might be involved. In the present study, a battery of hormonal and metabolic variables were measured in eight young and eight elderly healthy males undergoing elective inguinal hernial repair under general anesthesia. Blood was drawn before induction of anesthesia, at skin incision, and one, two, and six hours after skin incision. The findings were: 1) Plasma cortisol increase was significantly higher in elderly than in young controls. 2) Plasma renin level was lower in old age, but renin-aldosterone and electrolyte response patterns were alike in the two groups. 3) Thyroid parameters, in terms of serum T4, serum T3, serum rT3, and T3-resin uptake, responded normally to surgery and showed no age-related differences. 4) The hyperglycemic response was not significantly influenced by age indicating unchanged glycoregulatory mechanisms also verified by determinations of plasma catecholamines, cAMP, and insulin. 5) Blood lymphocyte count was constantly lower in elderly than in young and decreased with time, but the age-related difference was not significant. 6) Blood polymorphonuclear leukocytes showed an increase of the same magnitude in both age groups, although at a significantly slower rate in the elderly. It is concluded that age affects some aspects of the initial endocrine-metabolic response to surgery.

Acute development of low T3syndrome and changes in pituitary-adrenocortical function after elective cholecystectomy in women: some differences between young and elderly patients

“…Unfortunately, we could not find any comparative data in the literature. The schedule of anaesthesia used in this study was about the same as used by Blichert-Toft et al [23], but these authors did not measure the TSH level. However, our data resemble those of Adami et al [-13] and Charters et ul.…”

Local Analgesia Prevents the Cortisol and Glycaemic Responses to Cataract Surgery

“…The effects of age on the metabolic and endocrine response to surgery have received little attention. Blichert-Toft and colleagues [10] compared the response to inguinal herniorraphy in men aged 20-30 yr and 70-75 yr and observed only small differences. Similarly, age was found not to be a significant variable in determining the hormonal and metabolic changes associated with cholecystectomy [11].…”

Value of Basal Plasma Cortisol Assays in the Assessment of Pituitary‐adrenal Insufficiency

“…Levels of plasma cortisol (or 1 1-hydroxycorticosteroids) during various forms of stress conditions, e.g. acute medical illnesses (Jacobs & Nabarro, 1969), major surgery (Mattingly & Tyler, 1965;Jasani et al, 1968;Kehlet & Binder, 1973;Blichert-Toft et al, 1979), hypoglycaemia (Jasani et al, 1967;Wand & Ney, 1985) and after injection of bacterial pyrogen (Takebe et al, 1966) have been reported. Sandberg et al (1957) reported low plasma 17-hydroxycorticosteroids in patients who had been treated with glucocorticoids and in patients with Addison's disease.…”