Adrenocortical Response to Surgical Operations in Patients Treated With Corticosteroids or Corticotropin Prior to Surgery

Effect of corticotrophin therapy on pituitary-adrenal function.

“…First, since no value to the patient derives from the demonstration of a normal response to hypoglycaemia, it is important to determine whether this reflects his ability to respond to other stresses, such as surgery or trauma. Some observations are available from others as well as ourselves: patients receiving ACTH therapy, when subjected to surgery, have produced increased plasma steroid levels (Marks, Donovan, Duncan, and Karger, 1959;Amatruda, Hollingsworth, D'Esopo, Upton, and Bondy, 1960). We have studied this problem more extensively, and have shown that, in four patients receiving ACTH treatment who underwent five surgical operations, there was a normal plasma cortisol response during operation, which matched the maximum response obtained in these patients by previously infusing supramaximum doses of ACTH.…”

Modification of Plasma Corticosteroid Concentrations during and after Surgery by Epidural Blockade

“…However, this therapy achieved steroid concentrations twice those normally found in response to surgery. The clinical improvement may have been similar to that seen in shocked patients treated with hydrocortisone who have normal adrenocortical function (Marks et al, 1959). Study of both medical and surgical patients with arterial hypotension due to suspected adrenocortical failure (Mattingly and Tyler, 1965) showed raised plasma corticosteroid concentrations in all 47 cases.…”

Evaluation of Pituitary‐adrenocortical Function in Patients With Rheumatoid Arthritis Following Steroid Therapy*

“…20 who observed a normal response if the patients had been treated with adrenocorticotropin together with corticosteroids.…”

“…Conversely, the intravenous injection of pyrogens failed to elicit the expected rise when patients had been only on corticosteroids.17J8 The effect of surgery itself, known as inducing an increase in plasma corticosteroid concentrati~n,'~ was examined by Marks et a1. 20 who observed a normal response if the patients had been treated with adrenocorticotropin together with corticosteroids.…”