Changes in glucocorticoid and mineralocorticoid hormone levels due to compensation for ileostomy losses.
BACKGROUND
The Ileo-Pouch-Anal-Anastomosis (IPAA) is the standard restorative procedure for Ulcerative Colitis and Familial Adenomatous Polyposis (FAP). IPAA may lead to considerable losses of fluids, especially in association with a protective loop ileostomy.


OBJECTIVE
The aim of this study was to investigate adrenal mechanisms in the regulation of volume homeostasis immediately after IPAA and protective ileostomy.


METHODS
For that purpose, 20 patients out of our patient population with elective IPAA with ileostomy participated in this study between 1993 and 1997. In all patients, routine laboratory tests and gluco- and minealocorticoid hormone measurements were performed preoperatively and 10 days after operation.


RESULTS
These blood analyses indicated functional hyperaldosteronism immediately after IPAA. Significantly elevated levels of Aldosterone (36.4 +/- 25.1 ng/dl) and 18-OH-Corticosterone ( 173 +/- 11.3 ng/dl) were found. Among hormones with glucocorticoid effects, blood levels of Cortisol (10.4 +/- 4.8 microg/dl) were significantly elevated, while 11-Desoxycortiosterone (13.9 +/- 8.4 ng/dl) and Corticosterone (0.8 +/- 0.6 microg/dl) were not significantly elevated. Serum electrolytes remained unchanged.


CONCLUSIONS
Our results indicate that hormones with mineralocorticoid effects play a predominant role in the compensation of ileostomy losses after IPAA.
Huber
F X
FX
Department of Surgery, University of Heidelberg, Germany.
Lucas
M
M
Stern
J
J
Hinz
U
U
Haack
D
D
Heuschen
U
U
Herfarth
C
C
D000222:Adaptation, Physiological; D011125:Adenomatous Polyposis Coli / Q000601:surgery; D000328:Adult; D003093:Colitis, Ulcerative / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000032:analysis / Q000378:metabolism*; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000097:blood / Q000378:metabolism*; D011336:Probability; D016737:Proctocolectomy, Restorative / Q000009:adverse effects* / Q000379:methods; D011379:Prognosis; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D014883:Water-Electrolyte Imbalance / Q000209:etiology* / Q000503:physiopathology
D005938:Glucocorticoids; D008901:Mineralocorticoids