Acth Levels in Plasma in Preoperative and Surgically Stressed Patients*

Cooper, C; Nelson, Don H.

doi:10.1172/jci104618

Cited by 67 publications

(21 citation statements)

References 28 publications

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“…The rise in plasma ACTH observed in surgical patients was similar to that recently reported by Cooper and Nelson (6). Presumably, the rise in plasma 17-OHCS occurring during surgery is attributable to this increase in plasma ACTH.…”

Section: Discussionsupporting

confidence: 89%

Correlation of Plasma Acth Concentration With Adrenocortical Response in Normal Human Subjects, Surgical Patients, and Patients With Cushing's Disease*

Ney¹,

Shimizu²,

Nicholson³

et al. 1963

J. Clin. Invest.

122

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The role of ACTH in various clinical disorders has been difficult to ascertain because the available assay methods have lacked the sensitivity necessary for valid quantitation of the hormone in the plasma of normal subjects (1-4). Even the method of Lipscomb and Nelson (5), the most sensitive practical bioassay procedure now available, usually requires the injection of at least 0.05 mU of ACTH per rat, if responses are to be elicited that will be statistically significant without the use of a prohibitive number of animals. It is usually impractical to inject more than 5 ml of crude human plasma into a single rat. Therefore, in order to be accurately measurable by this procedure, the concentration of ACTH in the plasma must be at least 0.05 mU per 5 ml, or 1 mU per 100 ml.Numerous studies indicate that normal plasma levels of ACTH are well below this concentration. Byr the adrenal ascorbic acid depletion assay method, Sydnor, Sayers, Brown, and Tyler (1) were unable to detect ACTH in plasma of normal subjects, even after attempting to extract the hormone with oxvcellulose in preparation for the bioassay. These workers concluded that blood ACTH concentrations of normal human subjects were less than 0.5 mU per 100 ml. Using a similar procedure, Fujita (3) estimated the normal level of ACTH to be about 1 mU per L, i.e., 0.1 mU per 100 ml. Cooper and Nelson (6) were able to detect ACTH in the plasma of only 3 of 10 patients before surgery, by a method that they

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Section: Discussionsupporting

confidence: 89%

Correlation of Plasma Acth Concentration With Adrenocortical Response in Normal Human Subjects, Surgical Patients, and Patients With Cushing's Disease*

Ney¹,

Shimizu²,

Nicholson³

et al. 1963

J. Clin. Invest.

122

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“…The elevations of plasma cortisol and UFC concentrations noted during the continuous administration of CRF were (26)(27)(28). Synergy with other factors, as suggested by other authors (2-9), or an augmented ACTH response to pulsed rather than continuous endogenous CRF secretion may account for the higher levels seen in stress.…”

Section: Discussionmentioning

confidence: 99%

Continuous administration of synthetic ovine corticotropin-releasing factor in man. Physiological and pathophysiological implications.

Schulte¹,

Chrousos²,

Gold³

et al. 1985

J. Clin. Invest.

104

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The continuous 24-h infusion of a maximally stimulating dose(1 gg/kg per h) of ovine corticotropin-releasing factor (CRF) in man caused a modest elevation of plasma cortisol (17.2±1.4 gg/dl) and urinary-free cortisol (173±43 gg/24 h) concentrations, which was far less than that seen with a maximally stimulating dose of ACTH (50.4±2.2 Mg/dl and 1,200±94 gg/ 24 h, respectively). The circadian rhythms of plasma ACUH and cortisol were preserved during CRF administration. An intravenous bolus injection of 1 ag/kg of ovine CRF given to normal volunteers under basal conditions resulted in elevated plasma ACTH and cortisol peak levels (28±6 pg/ml and 15.0±1.0 gg/dl, respectively). However, no plasma ACTH and cortisol responses were observed when an identical CRF stimulation test was given at the end of the continuous infusion. These findings suggest that the stimulatory activity of exogenous CRF on the ACTH-secreting cells of the pituitary gland is restrained by the negative feedback of cortisol. The persistent circadian rhythm of ACTH, despite a constant level of plasma CRF during the infusion, suggests that the circadian variation in the activity of the hypothalamic-pituitary-adrenal axis cannot be explained solely by circadian periodicity of the endogenous CRF stimulus.

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“…8,25,26 During surgical procedures such as laparotomy, serum corticotropin and cortisol concentrations rise rapidly but usually return to base-line values within 24 to 48 hours 27,28 (Fig. 1A).…”

Section: The Normal Response Of the Hypothalamic-pituitary-adrenal Axmentioning

confidence: 99%

Corticosteroid Therapy in Severe Illness

1997

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Acth Levels in Plasma in Preoperative and Surgically Stressed Patients*

Cited by 67 publications

References 28 publications

Correlation of Plasma Acth Concentration With Adrenocortical Response in Normal Human Subjects, Surgical Patients, and Patients With Cushing's Disease*

Correlation of Plasma Acth Concentration With Adrenocortical Response in Normal Human Subjects, Surgical Patients, and Patients With Cushing's Disease*

Continuous administration of synthetic ovine corticotropin-releasing factor in man. Physiological and pathophysiological implications.

Corticosteroid Therapy in Severe Illness

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