Pituitary-adrenal responses following major abdominal surgery

Dimopoulou, Ioanna; Tzanela, Marinella; Vassiliadi, Dimitra Argyro; Mavrou, Irini; Kopterides, Petros; Orfanos, Stylianos E.; Κοτανίδου, Αναστασία; Kontogiannopoulou, S.; Vasdekis, S.; Tsangaris, Iraklis; Armaganidis, Apostolos; Macheras, Anastasios; Ilias, Ιoannis; Kostopanagiotou, Georgia; Tsagarakis, Stylianos

doi:10.14310/horm.2002.1203

Cited by 25 publications

(20 citation statements)

References 44 publications

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“…Dimopoulou et al . showed that CBG levels drop immediately after intra‐abdominal surgery, but recover by day 2 postoperatively . Postoperative total CBG levels at 474 nmol/l, however, remain higher than the levels seen in our patients with sepsis or septic shock; thus, we do not believe that surgery was a confounding influence in our study.…”

Section: Discussioncontrasting

confidence: 60%

Depletion of high‐affinity corticosteroid‐binding globulin corresponds to illness severity in sepsis and septic shock; clinical implications

Nenke

Rankin

Chapman

et al. 2015

Clinical Endocrinology

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Section: Discussioncontrasting

confidence: 60%

Depletion of high‐affinity corticosteroid‐binding globulin corresponds to illness severity in sepsis and septic shock; clinical implications

Nenke

Rankin

Chapman

et al. 2015

Clinical Endocrinology

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“…Dissociation between cortisol and ACTH levels following major surgery has been observed, particularly on the first postoperative day, whereas ACTH levels spread strongly immediately after surgery [23,37,40,41]. ACTH is produced primarily by the anterior pituitary gland.…”

Section: Discussionmentioning

confidence: 99%

Genetic variation of TLR4 influences immunoendocrine stress response: an observational study in cardiac surgical patients

et al. 2011

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IntroductionSystemic inflammation (for example, following surgery) involves Toll-like receptor (TLR) signaling and leads to an endocrine stress response. This study aims to investigate a possible influence of TLR2 and TLR4 single nucleotide polymorphisms (SNPs) on perioperative adrenocorticotropic hormone (ACTH) and cortisol regulation in serum of cardiac surgical patients. To investigate the link to systemic inflammation in this context, we additionally measured 10 different cytokines in the serum.MethodsA total of 338 patients admitted for elective cardiac surgery were included in this prospective observational clinical cohort study. Genomic DNA of patients was screened for TLR2 and TLR4 SNPs. Serum concentrations of ACTH, cortisol, interferon (IFN)-γ, interleukin (IL)-1β, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, tumor necrosis factor (TNF)-α and granulocyte macrophage-colony stimulating factor (GM-CSF) were determined before surgery, immediately post surgery and on the first postoperative day.ResultsThirteen patients were identified as TLR2 SNP carriers, 51 as TLR4 SNP carriers and 274 patients as non-carriers. Basal levels of ACTH, cortisol and cytokines did not differ among groups. In all three groups a significant, transient perioperative rise of cortisol could be observed. However, only in the non-carrier group this was accompanied by a significant ACTH rise. TLR4 SNP carriers had significant lower ACTH levels compared to non-carriers (mean (95% confidence intervals)) non-carriers: 201.9 (187.7 to 216.1) pg/ml; TLR4 SNP carriers: 149.9 (118.4 to 181.5) pg/ml; TLR2 SNP carriers: 176.4 ((110.5 to 242.3) pg/ml). Compared to non-carriers, TLR4 SNP carriers showed significant lower serum IL-8, IL-10 and GM-CSF peaks (mean (95% confidence intervals)): IL-8: non-carriers: 42.6 (36.7 to 48.5) pg/ml, TLR4 SNP carriers: 23.7 (10.7 to 36.8) pg/ml; IL-10: non-carriers: 83.8 (70.3 to 97.4) pg/ml, TLR4 SNP carriers: 54.2 (24.1 to 84.2) pg/ml; GM-CSF: non-carriers: 33.0 (27.8 to 38.3) pg/ml, TLR4 SNP carriers: 20.2 (8.6 to 31.8) pg/ml). No significant changes over time or between the groups were found for the other cytokines.ConclusionsRegulation of the immunoendocrine stress response during systemic inflammation is influenced by the presence of a TLR4 SNP. Cardiac surgical patients carrying this genotype showed decreased serum concentrations of ACTH, IL-8, IL-10 and GM-CSF. This finding might have impact on interpreting previous and designing future trials on diagnosing and modulating immunoendocrine dysregulation (for example, adrenal insufficiency) during systemic inflammation and sepsis.

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“…Dimopoulou et al concluded that, at an early phase following major surgery, elevated cortisol is associated with high ACTH. [3] Wakim and Sledge et al…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic consideration for caesarean delivery of a parturient without ′The Master Gland′

Mistry

Bhati

Chatterjee

et al. 2015

J Obstet Anaesth Crit Care

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Pituitary-adrenal responses following major abdominal surgery

Cited by 25 publications

References 44 publications

Depletion of high‐affinity corticosteroid‐binding globulin corresponds to illness severity in sepsis and septic shock; clinical implications

Depletion of high‐affinity corticosteroid‐binding globulin corresponds to illness severity in sepsis and septic shock; clinical implications

Genetic variation of TLR4 influences immunoendocrine stress response: an observational study in cardiac surgical patients

Anaesthetic consideration for caesarean delivery of a parturient without ′The Master Gland′

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