title: Pulsatile activation of the hypothalamic-pituitary-adrenal axis during major surgery.
abstract: To examine the response of the hypothalamic-pituitary-adrenal (HPA) axis to severe surgical stress, we measured the immunoreactive plasma levels of corticotropin-releasing hormone (CRH), corticotropin, cortisol, arginine-vasopressin (AVP), atrial natriuretic factor (ANF), neuropeptide Y (NPY), interleukin-1 (IL-1), IL-6, interferon gamma (INF), and tumor necrosis factor-alpha (TNF-alpha) in eight patients with Zollinger-Ellison syndrome (ZES) or mediastinal parathyroid carcinoma, all undergoing major surgery with a standardized anesthetic technique. Blood samples were drawn the morning before surgery, every 10 to 30 minutes throughout surgery (average, 308.7 +/- 15 minutes), and every morning for the next 4 postoperative days (POD). During surgery, plasma CRH concentrations were slightly but not significantly elevated compared with those before surgery and with those of the next 4 POD. However, the values were within the normal range (less than 2.2 pmol/L) and showed 8.9 +/- 0.6 pulses (one pulse every 34.7 +/- 1.6 minutes). Plasma corticotropin, on the other hand, was quite elevated, but was also released in a pulsatile fashion during the surgical procedure (one pulse every 36.7 +/- 1.6 minutes). Most of these secretory episodes of corticotropin were temporally related to those of CRH. Corticotropin returned to basal levels on the first POD and remained so for all 4 POD. Plasma cortisol concentrations increased steadily during surgery and remained elevated the first POD. Cortisol showed 6.2 +/- 1.1 pulses during the operative sampling period (one pulse every 71.8 +/- 13 minutes). Plasma AVP concentrations were also markedly elevated during surgery, but individual secretory pulses were not detected.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Developmental Endocrinology Branch, National Institute of Child Health and Human Development, Bethesda, MD 20892.
authors.forename: A E
authors.initials: AE
authors.lastname: Calogero
authors.forename: J A
authors.initials: JA
authors.lastname: Norton
authors.forename: B C
authors.initials: BC
authors.lastname: Sheppard
authors.forename: S J
authors.initials: SJ
authors.lastname: Listwak
authors.forename: D T
authors.initials: DT
authors.lastname: Cromack
authors.forename: R
authors.initials: R
authors.lastname: Wall
authors.forename: R T
authors.initials: RT
authors.lastname: Jensen
authors.forename: G P
authors.initials: GP
authors.lastname: Chrousos
mesh_terms: D016207:Cytokines / Q000097:blood; D006728:Hormones / Q000097:blood; D006801:Humans; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000503:physiopathology / Q000601:surgery*; D010913:Pituitary-Adrenal System / Q000503:physiopathology*; D015043:Zollinger-Ellison Syndrome / Q000097:blood / Q000503:physiopathology / Q000601:surgery*
chemical_list: D016207:Cytokines; D006728:Hormones