title: Is perioperative systemic inflammation the result of insufficient cortisol production in patients with colorectal cancer?
abstract: BACKGROUND
  Patients with colorectal cancer who have a raised systemic inflammatory response before surgery have been shown to have poorer long-term and short-term outcomes. The presence of an ongoing systemic inflammatory response in these patients may be due to impaired cortisol production. The aim of the present study was to examine the relationship between the perioperative systemic inflammatory response and endogenous cortisol production.
  
  
  METHODS
  A prospective study was performed to incorporate the assessment of adrenocortical function using synthetic adrenocorticotrophic hormone, a short Synacthen test, as part of the preoperative assessment of patients undergoing resection for colorectal cancer.
  
  
  RESULTS
  A total of 80 patients underwent short Synacthen testing. There were no significant associations between the baseline, 30 min, or change (both relative and absolute) in cortisol and age (all p > 0.10), sex (all p > 0.10), site (all p > 0.10), TNM stage (all p > 0.10), modified Glasgow prognostic score (all p > 0.10), NLR (all p > 0.10), white cell count (all p > 0.10) or postoperative C-reactive protein concentrations (all p > 0.10).
  
  
  CONCLUSIONS
  Impaired cortisol production was uncommon in patients with potentially curable colorectal cancer. The presence of a perioperative systemic inflammatory response was not significantly associated with impaired cortisol production.
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Royal Infirmary, Glasgow, UK. michelle.ramanathan@gmail.com
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Ramanathan
authors.forename: Campbell S D
authors.initials: CS
authors.lastname: Roxburgh
authors.forename: Graeme J K
authors.initials: GJ
authors.lastname: Guthrie
authors.forename: Clare
authors.initials: C
authors.lastname: Orange
authors.forename: Dinesh
authors.initials: D
authors.lastname: Talwar
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000367:Age Factors; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D015179:Colorectal Neoplasms / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000172:deficiency / Q000378:metabolism; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D059035:Perioperative Period; D011446:Prospective Studies; D012463:Saliva / Q000378:metabolism; D012737:Sex Factors; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000209:etiology
chemical_list: D002097:C-Reactive Protein; D006854:Hydrocortisone