title: Pituitary-adrenal responses following major abdominal surgery.
abstract: 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.
  
  
  METHODS
  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 mug) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 2nd Department of Critical Care Medicine, Attikon Hospital, Athens University School of Medicine, Athens, Greece.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Dimopoulou
authors.forename: Marinella
authors.initials: M
authors.lastname: Tzanela
authors.forename: Dimitra
authors.initials: D
authors.lastname: Vassiliadi
authors.forename: Irini
authors.initials: I
authors.lastname: Mavrou
authors.forename: Petros
authors.initials: P
authors.lastname: Kopterides
authors.forename: Stylianos
authors.initials: S
authors.lastname: Orfanos
authors.forename: Anastasia
authors.initials: A
authors.lastname: Kotanidou
authors.forename: Styliani
authors.initials: S
authors.lastname: Kontogiannopoulou
authors.forename: Spyridon
authors.initials: S
authors.lastname: Vasdekis
authors.forename: Iraklis
authors.initials: I
authors.lastname: Tsangaris
authors.forename: Apostolos
authors.initials: A
authors.lastname: Armaganidis
authors.forename: Anastasios
authors.initials: A
authors.lastname: Macheras
authors.forename: Ioannis
authors.initials: I
authors.lastname: Ilias
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tsagarakis
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000304:Adrenal Cortex Function Tests; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000368:Aged; D002352:Carrier Proteins / Q000097:blood; D003082:Colectomy / Q000009:adverse effects; D003687:Dehydroepiandrosterone / Q000097:blood; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006728:Hormones / Q000097:blood*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects; D010912:Pituitary-Adrenal Function Tests; D010913:Pituitary-Adrenal System / Q000378:metabolism*; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects
chemical_list: D002352:Carrier Proteins; D006728:Hormones; C027091:cortisol binding globulin; D003687:Dehydroepiandrosterone; D019314:Dehydroepiandrosterone Sulfate; D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone