title: Perioperative response of leptin and the tumor necrosis factor alpha system in morbidly obese patients. Influence of cortisol inhibition by etomidate.
abstract: BACKGROUND
  Leptin, tumor necrosis factor alpha (TNFalpha) and soluble TNFalpha receptors are secreted by the adipose tissue. Surgery induces a complex cytokine and neurohormonal response. The aim of our study was to investigate the perioperative response of leptin and the TNFalpha system in morbidly obese patients submitted to gastroplasty, and the possible involvement of cortisol in their responses.
  
  
  METHODS
  Serum cortisol, adrenocorticotropic hormone (ACTH), leptin, TNFalpha and soluble TNFalpha receptor I were measured in 22 morbidly obese women (11 anesthetized with thiopental and 11 with etomidate, a well known inhibitor of cortisol synthesis). Samples were collected before anesthesia induction, just before surgical incision, and 2, 4, 6, 12, 24 and 48 h after the start of surgery.
  
  
  RESULTS
  Baseline serum leptin correlated with body mass index (r=0.567, P=0.007). Baseline serum leptin and TNFalpha were higher than normal. Cortisol release was inhibited in the etomidate group with a subsequent higher stimulation of ACTH release. A statistically significant decrease in serum leptin levels was observed in both groups at 2, 4, 6 and 48 h, compared with basal values. A similar decrease in serum TNFalpha levels was observed in both groups, but the decrease reached significance only in the etomidate group. Serum soluble TNFalpha receptor I did not decrease. No differences were found between the two groups in leptin, TNFalpha or soluble TNFalpha receptor I concentrations at any time.
  
  
  CONCLUSIONS
  Serum leptin and TNFalpha levels decrease in obese patients during gastroplasty. Transitory inhibition of cortisol release does not alter this response.
authors.affiliation: Endocrine Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Montalbán
authors.forename: I
authors.initials: I
authors.lastname: Del Moral
authors.forename: M T
authors.initials: MT
authors.lastname: García-Unzueta
authors.forename: M A
authors.initials: MA
authors.lastname: Villanueva
authors.forename: J A
authors.initials: JA
authors.lastname: Amado
mesh_terms: D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D018686:Anesthetics, Intravenous / Q000494:pharmacology*; D005045:Etomidate / Q000494:pharmacology*; D005260:Female; D015391:Gastroplasty; D006801:Humans; D006854:Hydrocortisone / Q000037:antagonists & inhibitors* / Q000097:blood; D007813:Laparotomy; D020738:Leptin / Q000097:blood*; D008875:Middle Aged; D009767:Obesity, Morbid / Q000097:blood*; D054411:Receptors, Leptin; D018124:Receptors, Tumor Necrosis Factor / Q000378:metabolism; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D018686:Anesthetics, Intravenous; C515448:LEPR protein, human; D020738:Leptin; D054411:Receptors, Leptin; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone; D005045:Etomidate