Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery

Roth-Isigkeit, Angela; Schmucker, P.

doi:10.1016/s0039-128x(97)00069-x

Cited by 46 publications

(35 citation statements)

References 9 publications

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“…33 On PoD1, another remarkable dissociation between ACTH (low) and FCI (high) was observed. Such dissociation has been previously described in stressful conditions, such as those caused by surgery 3,26,33,34 or critical illness. 35 This phenomenon remains poorly defined and has been attributed to factors which directly stimulate the adrenal or interfere with CRH and ACTH release.…”

Section: Discussionmentioning

confidence: 62%

Pituitary-adrenal responses following major abdominal surgery

Dimopoulou¹,

Tzanela²,

Vassiliadi³

et al. 2008

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OBjeCTive: Perioperative pituitary-adrenal responses after major abdominal surgery have not been well characterized. The aim of the present study was to further clarify perioperative pituitary-adrenal responses. DeSiGN: Thirty-six patients (20 men), aged 68±10 years (mean±SD), undergoing major abdominal operations were studied. Total cortisol (TC), Adrenocorticotropic Hormone (ACTH), corticosteroid-binding globulin (CBG), dehydroepiandrosterone (DHeA) and its sulphate (DHeAS) were measured preoperatively (PreOp), on the day of surgery (DoS) and on the first and second postoperative days (PoD1 and PoD2). The free cortisol index (FCi) was also calculated. in addition, patients underwent a low-dose (1 μg) ACTH stimulation test, preoperatively and on PoD1, to assess adrenal responsiveness to ACTH. ReSulTS: TC, FCi, ACTH and DHeA were increased, while DHeAS and CBG declined on DoS compared to PreOp levels. On PoD1, plasma ACTH was lower compared to the preoperative levels, FCi remained elevated, DHeA, DHeAS and TC returned to their baseline values, while CBG was still low. On PoD2, ACTH and CBG were low and FCi returned to its PreOp levels. Postoperatively, stimulated FCi was higher compared to the PreOp value. CONCluSiON: At an early phase following major surgery, elevated cortisol is associated with high ACTH. Despite HPA activation and a concomitant rise in DHeA levels, DHeAS declines. later on, a remarkable dissociation between ACTH (low) and cortisol (high) is observed, which is attributed, at least in part, to increased adrenal responsiveness to ACTH.

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Section: Discussionmentioning

confidence: 62%

Pituitary-adrenal responses following major abdominal surgery

Dimopoulou¹,

Tzanela²,

Vassiliadi³

et al. 2008

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“…There is increasing evidence of DAC under severe stress [6, 7, 8, 9, 10], which implies the existence of an ACTH-independent cortisol secretion from the adrenal cortex. However, in previous studies, we could not find any definition of DAC in terms of the plasma or serum concentration itself.…”

Section: Discussionmentioning

confidence: 99%

“…In general, cortisol secretion from the adrenal cortex is performed in an adrenocorticotropin (ACTH)-dependent manner. However, there is some evidence for the dissociation between the plasma ACTH and cortisol secretion under severely stressful conditions, such as those caused by upper abdominal surgery [6], coronary artery bypass graft surgery [7], severe burns [8], stroke [9]and sepsis [10]. This evidence implies the existence of an ACTH-independent cortisol secretion from the adrenal cortex.…”

Section: Introductionmentioning

confidence: 99%

Dissociation between Plasma Adrenocorticotropin and Serum Cortisol Level during the Early Postoperative Period after Gastrectomy

Cho

Kim²,

Cho³

et al. 2000

Horm Res Paediatr

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We demonstrated the dissociation between plasma adrenocorticotropin (ACTH) and serum cortisol levels during the early recovery period after radical gastrectomy in 9 of 31 patients with gastric adenocarcinoma. Patients with the dissociation between plasma ACTH and serum cortisol levels (DAC) showed a sustained elevation of serum cortisol level on the first or second postoperative day, while the plasma ACTH level returned to its preoperative state. These patients also had more advanced cancers (p < 0.05) and suffered from more postoperative complications (p < 0.05) than those without DAC. In these patients with DAC, serum cortisol and interleukin (IL)-6 levels remained higher on the second postoperative day than in those of the patients without DAC (21.80 ± 1.57 vs. 13.68 ± 0.72 μg/dl, p < 0.001, and 74.31 ± 15.65 vs. 18.75 ± 3.14 pg/ml, p < 0.001, respectively). On the second postoperative day, serum IL-6 levels showed a significant correlation with serum cortisol levels in all patients (r = 0.511, p < 0.01). These results suggest that the DAC during the early postoperative period after radical gastrectomy is associated with advanced stage of cancer and postoperative complication, and that the increased serum IL-6 level is at least in part responsible for maintaining the elevated serum cortisol.

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“…125,127,129 This has been confirmed in coronary artery bypass graft operations, although not by all studies, 130 where basal and stimulated cortisol levels have been correlated with severity of stress, peaking shortly after extubation and being similar to levels during other major surgical procedures and critical illness. 131,132 Studies demonstrate that this principally occurs through cytokine regulation of the HPA axis primarily by direct or indirect stimulation of hypothalamic CRH, especially by IL-1, IL-6, and TNF-α, and also by directly affecting the pituitary and adrenal glands. 133 It is of interest that in a subpopulation of patients exposed to cardiopulmonary bypass (CPB), this systemic reaction can propagate a huge pro-inflammatory response, similar to that seen in sepsis and termed SIRS (systemic inflammatory response syndrome).…”

Section: 128mentioning

confidence: 99%

The central CLOCK system and the stress axis in health and disease

Kassi¹,

Chrousos²

2013

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are secreted in the portal system in a circadian and highly concordant pulsatile fashion. The activity of the HPA axis is in fact characterized not only by a classic circadian rhythm, but also by an ultradian pattern of discrete pulsatile release of glucocorticoids. Glucocorticoids are the final effectors of the HPA axis. These hormones are pleiotropic and exert their effects through their ubiquitously distributed intracellular glucocorticoid receptors alpha and beta (GRα and GRβ, respectively), both members of the nuclear receptor superfamily.2 The circadian release of ACTH/cortisol in their characteristic pulsatile manner appears to be controlled by one or more pace makers, whose exact location in the brain has not as yet been fully explored in humans. These diurnal variations are perturbed during daily activities like eating, sleeping, etc., while they are more greatly disrupted under stress conditions. Dysregulation of the HPA axis in basal conditions or in response to acute or chronic (including psychosocial) stress appear to be closely related to the onset and/or the progression of several diseases, such as metabolic syndrome, depression, and autoimmune diseases.Herein, we aim to review the current knowledge of the mechanisms that regulate ACTH and cortisol secretion under nonstressful conditions maintaining homeostasis as well as in stressful circumstances in an attempt to delineate the involvement of the 'stressresponse' component in disorders afflicting a large number of people.

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Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery

Cited by 46 publications

References 9 publications

Pituitary-adrenal responses following major abdominal surgery

Pituitary-adrenal responses following major abdominal surgery

Dissociation between Plasma Adrenocorticotropin and Serum Cortisol Level during the Early Postoperative Period after Gastrectomy

The central CLOCK system and the stress axis in health and disease

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