Hormonal Responses to Graded Surgical Stress
Abstract
We tested the hypothesis that selected hormonal responses to surgery reflect the degree of surgical stress. Plasma norepinephrine, epinephrine, thromboxane B2, cortisol, serum angiotensin converting enzyme, thyroxine, triiodothyronine, free thyroxine, and free triiodothyronine levels were measured preoperatively, and then one hour, 24 hours, and five days postoperatively in three groups of patients. The groups were as follows: group 1, "minimal" stress, eg, inguinal hernia repair (n = 10); group 2, "moderate" stress, eg, cholecystectomy (n = 12); and group 3, "severe" stress, eg, subtotal colectomy (n = 9). Patients in group 1 showed no significant surgery-induced changes in hormonal values. The stress-induced changes in patients in groups 2 and 3 were seen at one and occasionally 24 hours; however, by five days postoperatively, circulating hormone values had returned to preoperative levels. Increases in plasma cortisol, norepinephrine, and epinephrine, and decreases in serum angiotensin converting enzyme levels characterized the surgery-induced hormonal changes. Conclusions are as follows: hormonal responses do reflect the degree of surgical stress; the hormonal changes are transient, lasting no longer than 24 hours in patients after uncomplicated surgery; hormonal responses to minimal surgical stress are negligible.
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The cortisol concentration achieved during steroid infusion is equivalent to the adrenal response seen after severe trauma or surgical stress.
“This concentration is equivalent to the adrenal response seen after severe trauma or surgical stress (9,30,35,47).”
From Impaired basal glucose effectiveness but unaltered fasting glucose release and gluconeogenesis during short-term hypercortisolemia in healthy subjects (2004) · cites this paper as [9]
In perioperative patients, serum cortisol levels often reflect the degree of surgical stress.
“Similarly in perioperative patients, serum cortisol levels often reflect the degree of surgical stress.22,23”
From Adrenal crisis: prevention and management in adult patients (2019) · cites this paper as [22]
Cites
Stress hormones: their interaction and regulation
Axelrod, J., & Reisine, T. D. (1984) · Science · doi:10.1126/science.6143403 · Cited by 1,527 · see citing works
Circadian Rhythms of Epinephrine and Norepinephrine in Man*
LINSELL, C. R., LIGHTMAN, S. L., MULLEN, P. E., BROWN, M. J., & CAUSON, R. C. (1985) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-60-6-1210 · Cited by 399 · see citing works
Transient hypogonadotropic hypogonadism caused by critical illness
WOOLF, P. D., HAMILL, R. W., McDONALD, J. V., LEE, L. A., & KELLY, M. (1985) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-60-3-444 · Cited by 338 · see citing works
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Cited by
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Bornstein, S. R., Allolio, B., Arlt, W., Barthel, A., Don-Wauchope, A., Hammer, G. D., Husebye, E. S., Merke, D. P., Murad, M. H., Stratakis, C. A., et al. (2016) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2015-1710 · Cited by 1,769 · see citing works
“Studies provide evidence for an endogenous increase in cortisol during anesthesia, surgery, trauma, and critical illness, with great interindividual variation (137–141).”
BackgroundDecreased memory performance in healthy humans induced by stress-level cortisol treatment
Newcomer, J. W. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.6.527 · Cited by 546 · see citing works
Diagnosis of Adrenal Insufficiency
Dorin, R. I., Qualls, C. R., & Crapo, L. M. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-139-3-200308050-00009 · Cited by 374 · see citing works
Perioperative glucocorticoid coverage. A reassessment 42 years after emergence of a problem
Salem, M., Tainsh, R. E., Bromberg, J., Loriaux, D. L., & Chernow, B. (1994) · Annals of Surgery · doi:10.1097/00000658-199404000-00013 · Cited by 357 · see citing works
Self-citationAdrenocortical function in critically ill patients 24 h after a single dose of etomidate
Absalom, Pledger, & Kong (1999) · Anaesthesia · doi:10.1046/j.1365-2044.1999.01003.x · Cited by 241 · see citing works
The cortisol stress response induced by surgery: A systematic review and meta‐analysis
Prete, A., Yan, Q., Al‐Tarrah, K., Akturk, H. K., Prokop, L. J., Alahdab, F., Foster, M. A., Lord, J. M., Karavitaki, N., Wass, J. A., et al. (2018) · Clinical Endocrinology · doi:10.1111/cen.13820 · Cited by 192 · see citing works
Corticosteroid–serotonin interactions in depression: a review of the human evidence
Porter, R. J., Gallagher, P., Watson, S., & Young, A. H. (2004) · Psychopharmacology · doi:10.1007/s00213-004-1774-1 · Cited by 169 · see citing works
Jones, S. L., Trainer, P. J., Perry, L., Wass, J. A. H., Besser, G. M., & Grossman, A. (1994) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1994.tb03793.x · Cited by 159 · see citing works
Peri‐operative steroid supplementation
Nicholson, G., Burrin, J. M., & Hall, G. M. (1998) · Anaesthesia · doi:10.1046/j.1365-2044.1998.00578.x · Cited by 143 · see citing works
Adrenal crisis: prevention and management in adult patients
Dineen, R., Thompson, C. J., & Sherlock, M. (2019) · Therapeutic Advances in Endocrinology and Metabolism · doi:10.1177/2042018819848218 · Cited by 123 · see citing works
Haemodynamic and hormonal responses to heat exposure in a Finnish sauna bath
Kukkonen-Harjula, K., Oja, P., Laustiola, K., Vuori, I., Jolkkonen, J., Siitonen, S., & Vapaatalo, H. (1989) · European Journal of Applied Physiology and Occupational Physiology · doi:10.1007/bf02330710 · Cited by 108 · see citing works
Woolf, P. D., Cox, C., Kelly, M., Nichols, D., McDonald, J. V., & Hamill, R. W. (1990) · Alcoholism Clinical and Experimental Research · doi:10.1111/j.1530-0277.1990.tb01838.x · Cited by 60 · see citing works
Nielsen, M. F., Caumo, A., Chandramouli, V., Schumann, W. C., Cobelli, C., Landau, B. R., Vilstrup, H., Rizza, R. A., & Schmitz, O. (2004) · American Journal of Physiology-Endocrinology and Metabolism · doi:10.1152/ajpendo.00566.2002 · Cited by 53 · see citing works
Cortisol response to operative stress with anesthesia in healthy children
Taylor, L. K., Auchus, R. J., Baskin, L. S., & Miller, W. L. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-2148 · Cited by 44 · see citing works
Perioperative evaluation and management of patients on glucocorticoids
Chen Cardenas, S. M., Santhanam, P., Morris-Wiseman, L., Salvatori, R., & Hamrahian, A. H. (2022) · Journal of the Endocrine Society · doi:10.1210/jendso/bvac185 · Cited by 31 · see citing works
Improving outcomes in patients with adrenal insufficiency: a review of current and future treatments
Johannsson, G., Skrtic, S., Lennernäs, H., Quinkler, M., & Stewart, P. M. (2014) · Current Medical Research and Opinion · doi:10.1185/03007995.2014.925865 · Cited by 21 · see citing works
The effect of a steroid “burst” and long-term, inhaled fluticasone propionate on adrenal reserve
Nguyen, K.-L., Lauver, D., Kim, I., & Aresery, M. (2003) · Annals of Allergy, Asthma & Immunology · doi:10.1016/s1081-1206(10)62056-x · Cited by 20 · see citing works
Diagnosis and treatment of ACTH deficiency
Cooper, M. S., & Stewart, P. M. (2005) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-005-5224-0 · Cited by 16 · see citing works
Arafah, B. M. (2020) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgaa042 · Cited by 13 · see citing works
- Authors
- Chernow, B.
- Affiliations
- Harvard University (US)
- Corresponding author
- Chernow, Bart
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 1987-07-01
- Volume
- 147
- Issue
- 7
- Pages
- 1273
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W1966344978
- Cited by
- 459
- References
- 3
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 3 · 2023: 5 · 2022: 11 · 2021: 5 · 2020: 6 · 2019: 14 · 2018: 18 · 2017: 12 · 2016: 21 · 2015: 11 · 2014: 15 · 2013: 13 · 2012: 18
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- surgical stress, endocrine response, plasma norepinephrine, epinephrine, thromboxane B2, cortisol, angiotensin-converting enzyme, thyroid hormones, thyroxine, free triiodothyronine, free thyroxine, inguinal hernia repair, cholecystectomy, subtotal colectomy
- MeSH terms
- Adult, Aged, Catecholamines, Cholecystectomy, Colectomy, Female, Hernia, Inguinal, Hormones, Humans, Hydrocortisone, Male, Middle Aged, Postoperative Period, Stress, Physiological, Surgical Procedures, Operative, Thromboxane B2, Thyroid Hormones
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