title: Beta-endorphin, cortisol and postoperative delirium: a preliminary report.
abstract: A transient delirium, including hallucinations and disorientation, occurred at some time during a 48 to 72 hr postoperative period in patients recovering from elective surgery in an intensive care unit. The occurrence of delirium in these patients was associated with a significant and unusually prolonged postoperative increase in circulating levels of beta-endorphin (B-endorphin) and cortisol, and a total disruption of normal plasma circadian rhythms of B-endorphin and cortisol. Postoperative mean 24-hr plasma levels of B-endorphin and cortisol were not significantly different from preoperative baseline levels in those patients who did not exhibit post-surgical delirium. Circadian rhythms of B-endorphin and cortisol in the non-delirious patients also remained normal following surgery, although peak plasma concentrations were significantly phase-shifted to later in the day. A disruption in circadian rhythms of the endogenous opiate/hypothalamic-pituitary-adrenal axis may represent an important component of post-operative psychological changes that are frequently observed in the intensive care unit setting.
authors.forename: T K
authors.initials: TK
authors.lastname: McIntosh
authors.forename: H L
authors.initials: HL
authors.lastname: Bush
authors.forename: N S
authors.initials: NS
authors.lastname: Yeston
authors.forename: R
authors.initials: R
authors.lastname: Grasberger
authors.forename: M
authors.initials: M
authors.lastname: Palter
authors.forename: F
authors.initials: F
authors.lastname: Aun
authors.forename: R H
authors.initials: RH
authors.lastname: Egdahl
mesh_terms: D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D003693:Delirium / Q000097:blood* / Q000209:etiology / Q000503:physiopathology; D004723:Endorphins / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology; D001615:beta-Endorphin
chemical_list: D004723:Endorphins; D001615:beta-Endorphin; D006854:Hydrocortisone