Responses of the Hypothalamic-Pituitary-Adrenal and Renin-Angiotensin Axes and the Sympathetic System During Controlled Surgical and Anesthetic Stress
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 perio…
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Studies provide evidence for an endogenous increase in cortisol during anesthesia, surgery, trauma, and critical illness, with great interindividual variation.
“Studies provide evidence for an endogenous increase in cortisol during anesthesia, surgery, trauma, and critical illness, with great interindividual variation (137-141).”
From Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [138]
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- Authors
- UDELSMAN, R., NORTON, J. A., JELENICH, S. E., GOLDSTEIN, D. S., LINEHAN, W. M., LORIAUX, D. L., & CHROUSOS, G. P.
- Affiliations
- National Institutes of Health (US)
- Johns Hopkins University (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1987-05
- Volume
- 64
- Issue
- 5
- Pages
- 986-994
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1971663522
- Cited by
- 278
- References
- 27
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 4 · 2019: 8 · 2018: 13 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 8 · 2013: 10 · 2012: 5
- FWCI
- 8.10
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
- Health Sciences › Medicine › Psychiatry and Mental health › Cancer, Stress, Anesthesia, and Immune Response
- Keywords
- hypothalamic-pituitary-adrenal axis, renin-angiotensin system, sympathetic nervous system, surgical stress, parathyroidectomy, thyroid surgery, isoflurane anesthesia, ACTH secretion, cortisol, epinephrine, norepinephrine, plasma renin activity, postoperative recovery, anesthesia reversal, extubation
- MeSH terms
- Adrenocorticotropic Hormone, Adult, Aged, Anesthesia, Corticotropin-Releasing Hormone, Epinephrine, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Norepinephrine, Parathyroid Glands, Pituitary-Adrenal System, Renin, Renin-Angiotensin System, Stress, Physiological, Surgical Procedures, Operative, Sympathetic Nervous System, Thyroid Gland
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