Journal ArticleDOI
Responses of the hypothalamic-pituitary-adrenal and renin-angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress.
Robert Udelsman,Robert Udelsman,Jeffrey A. Norton,S E Jelenich,David S. Goldstein,W M Linehan,D L Loriaux,George P. Chrousos +7 more
TLDR
The data suggest that with modern anesthetic techniques patients undergoing neck surgery had mildly elevated plasma ACTH, cortisol, and epinephrine levels and all hormones returned to basal levels by the first post-operative day.Abstract:
We studied the responses of plasma CRH, ACTH, cortisol, norepinephrine, epinephrine, and renin activity in 11 patients undergoing parathyroid or thyroid surgery after identical preoperative sedation and during isoflurane (Forane) anesthesia. During surgical exploration, plasma CRH levels [10 +/- 2 (+/- SEM) pg/mL] remained at basal (unstimulated) levels, and plasma ACTH (11.5 +/- 1.4 pg/mL), cortisol (24 +/- 4 micrograms/dL), and epinephrine (35 +/- 10 pg/mL) concentrations remained within their normal morning ranges. The majority of the patients had no evidence of pulsatile ACTH secretion during the operation, but, rather, secreted ACTH and cortisol continuously. There was a small elevation of plasma norepinephrine and PRA which was associated with a small increase in heart rate and decrease in blood pressure. Anesthesia reversal, endotrachial extubation, and the early recovery period were associated with marked mean peak increases in plasma ACTH (173 +/- 45 pg/mL), cortisol (35 +/- 6 micrograms/dL), and epinephrine (220 +/- 56 pg/mL) and the return of plasma norepinephrine and PRA to basal levels. All hormones returned to basal levels by the first post-operative day. The data suggest that with modern anesthetic techniques patients undergoing neck surgery had mildly elevated plasma ACTH, cortisol, and epinephrine levels. Glucocorticoid secretion during the operation was maintained primarily by continuous rather than pulsatile ACTH secretion. The immediate postoperative period was associated with profound elevations of plasma ACTH, cortisol, and epinephrine. The major determinant of ACTH, cortisol, and epinephrine secretion was anesthesia reversal and recovery and not surgical trauma.read more
Citations
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Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline.
Stefan R. Bornstein,Bruno Allolio,Wiebke Arlt,Andreas Barthel,Andrew C. Don-Wauchope,Gary D. Hammer,Eystein S. Husebye,Deborah P Merke,M. Hassan Murad,Constantine A. Stratakis,David J. Torpy +10 more
TL;DR: A low diagnostic threshold in acutely ill patients, as well as in patients with predisposing factors, is suggested for pregnant women with unexplained persistent nausea, fatigue, and hypotension and a short corticotropin test is recommended as the "gold standard" diagnostic tool to establish the diagnosis.
Journal ArticleDOI
Association of perioperative myocardial ischemia with cardiac morbidity and mortality in men undergoing noncardiac surgery. The Study of Perioperative Ischemia Research Group
Dennis T. Mangano,Warren S. Browner,Milton Hollenberg,Martin J. London,Julio F. Tubau,Ida M. Tateo +5 more
TL;DR: In high-risk patients undergoing noncardiac surgery, early postoperative myocardial ischemia is an important correlate of adverse cardiac outcomes, and no other clinical, historical, or perioperative variable was associated with ischemic events.
Journal ArticleDOI
Intraadrenal Interactions in the Regulation of Adrenocortical Steroidogenesis
TL;DR: The splanchnic nerve in regulating adrenocortical neural function and the influence of adrenal innervation on adrenOCortical function are studied.
Journal ArticleDOI
Perioperative cardiac events in patients undergoing noncardiac surgery: a review of the magnitude of the problem, the pathophysiology of the events and methods to estimate and communicate risk
TL;DR: The magnitude of the problem, the pathophysiology of these events, approaches to risk assessment and communication of risk, and methods to facilitate the estimation of perioperative cardiac risk are reviewed.
Journal ArticleDOI
Acute Hypothalamic-Pituitary-Adrenal Responses to the Stress of Treadmill Exercise. Physiologic Adaptations to Physical Training
Anton Luger,Patricia A. Deuster,S. B. Kyle,William T. Gallucci,Montgomery Lc,Phillip W. Gold,D. L. Loriaux,George P. Chrousos +7 more
TL;DR: It is concluded that physical conditioning is associated with a reduction in pituitary-adrenal activation in response to a given workload and Alterations of the hypothalamic-pituitary and adrenal axis consistent with mild hypercortisolism and similar to findings in depression and anorexia nervosa were found only in highly trained runners.
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