Responses of the hypothalamic-pituitary-adrenal and renin-angiotensin axes and the sympathetic system during controlled surgical and anesthetic stress.

Author(s): Udelsman R, Norton JA, Jelenich SE, Goldstein DS, Linehan WM, Loriaux DL, Chrousos GP

Publication: J Clin Endocrinol Metab, 1987, Vol. 64, Page 986-94

PubMed ID: 3031124 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The purpose of this study was to determine the effects of surgical stress, anesthesia, and recovery on plasma CRH, ACTH, cortisol, norepinephrine, epinephrine, and PRA. Plasma was frozen at -70 degrees C and all specimens from each patient were analyzed in a single assay.

   Summary of Findings:

   The average hormone responses were examined of 11 patients. CRH concentrations remained close to or below the detection limit regardless of surgical stress. ACTH, plasma cortisol, and epinephrine concentrations rose rapidly after anesthesia reversal but gradually returned to normal levels by postoperative day 1. Norepinephrine was minimally elevated during exploration but unaffected by anesthesia reversal and extubation. PRA showed moderate increases during exploration and again during recovery on postoperative day 3, in between which there was a return to basal levels. Interestingly, while normal unstressed subjects would be expected to have 2-3 ACTH pulses during the anesthesia interval of about 4.5 hours, only 3 of 11 patients demonstrated 1-3 interoperative pulsatile ACTH secretions.

   Biospecimens

   • Bodily Fluid - Plasma
   • Bodily Fluid - Blood

   Preservative Types

   • Frozen

   Diagnoses:

   • Neoplastic - Benign
   • Neoplastic - Carcinoma
   • Other diagnoses

   Platform:

   Analyte	Technology Platform
   Peptide	Radioimmunoassay
   Steroid	Radioimmunoassay
   Protein	Radioimmunoassay
   Small molecule	HPLC

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Preaquisition	Diagnosis/ patient condition	Nodular goiter Hyperparathyroidism
   Preaquisition	Surgical procedure type	Parathyroid surgery Thyroid surgery
   Biospecimen Acquisition	Time of biospecimen collection	Preoperative Exploration Anesthesia reversal Extubation Recovery
   Biospecimen Acquisition	Anticoagulant	EDTA Heparin
   Preaquisition	Duration of anesthesia	4.5 h

   View more