Endocrine Function in Critical Heart Disease

Iliopoulos, Ilias; Huff, Christin; Graham, Eric M.

doi:10.1016/b978-1-4557-0760-7.00018-8

Cited by 2 publications

(2 citation statements)

References 69 publications

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“…These medica8ons play a crucial role in managing the pa8ent's condi8on by controlling the excessive catecholamine ac8vity, thus reducing the risk of quite severe metabolic and neuropsychiatric complica8ons. 17,18…”

Section: Catecholamine Suppressionmentioning

confidence: 99%

Metabolic and Cardiac Implications in Oshtoran Syndrome (H63D Syndrome Type-3): A Case Report

Diamandis,

Balaskas,

Merab

et al. 2024

Preprint

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Section: Catecholamine Suppressionmentioning

confidence: 99%

Metabolic and Cardiac Implications in Oshtoran Syndrome (H63D Syndrome Type-3): A Case Report

Diamandis,

Balaskas,

Merab

et al. 2024

Preprint

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“…Stress caused by cardiac surgery induces acute disturbances in the organism homeostasis, most notably during the procedures requiring cardiopulmonary bypass (CBP), which may ultimately lead to high postoperative morbidity and mortality. These disturbances are explained by the severe inflammatory state resulting from prolonged surgery, triggering neurohormonal responses of the hypothalamic-pituitary axes, which in turn are responsible for generalized pathological states [ 1 – 3 ]. The most remarkable among these neurohormonal responses is the surge in cortisol levels and decreased thyroid function, resulting from hyperstimulation of the hypothalamic-pituitary-adrenal axis and suppression of the hypothalamic-pituitary-thyroid one, respectively [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Patterns and Determinants of Change in Cortisol Levels and Thyroid Function as a Function of Cardiac Risk in Children Undergoing Cardiac Surgery

Al-Sofyani

Uddin²,

Qulisy

et al. 2022

International Journal of Pediatrics

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Background. Children undergoing cardiac surgery with cardiopulmonary bypass (CPB) are exposed to the risk of hormonal imbalances resulting from acute stress, which may eventually result in high postoperative mortality and morbidity. Objective. We assessed adrenal and thyroid hormonal changes and their determinants following cardiac surgery in children and explored their prognostic value in predicting cardiac outcomes. Study Design and Methods. A prospective cohort study was conducted at King Abdulaziz University Hospital (KAUH), between 2017 and 2018. The study involved 46 children aged 14 years or younger who underwent elective cardiac surgery with cardiopulmonary bypass. Serum levels of cortisol, TSH, fT3, and fT4 were measured preoperatively and 24, 48, and 72 hours after surgery. The cardiac risk was assessed using the risk adjustment for congenital heart surgery (RACHS) scale. A composite cardiovascular outcome was analyzed as a numerical variable and calculated as the number of cardiovascular events. Results. Overall, the changes in thyroid function parameters resulted in a U-shaped curve, while cortisol levels yielded a bell-shaped curve. The most significant changes occurred at 24 hours postop, including a decrease in mean TSH by 2.08 μIU/L ( p < 0.001 ), fT3 by 2.39 pmol/L ( p < 0.001 ), and fT4 by 2.45 pmol/L ( p < 0.001 ) and an increase in cortisol levels by 406.48 nmol/L ( p < 0.001 ) with respect to the baseline. Cortisol concentration peaked higher and recovered slower among patients with high cardiac risk than their counterparts. Cardiovascular outcomes were independently predicted by the extent of the decline in fT4 and TSH at 48 and 72 hours postop, with reference to the baseline, and by the cortisol level at 24 h postop, independent of the baseline, besides the RACHS category. Conclusion. Cardiac surgery among children yields a high adrenocortical response and a high incidence of nonthyroidal illness syndrome, increasing cardiovascular risk. A preventive management strategy involves improving surgical techniques to minimize trauma-related stress.

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Endocrine Function in Critical Heart Disease

Cited by 2 publications

References 69 publications

Metabolic and Cardiac Implications in Oshtoran Syndrome (H63D Syndrome Type-3): A Case Report

Metabolic and Cardiac Implications in Oshtoran Syndrome (H63D Syndrome Type-3): A Case Report

Patterns and Determinants of Change in Cortisol Levels and Thyroid Function as a Function of Cardiac Risk in Children Undergoing Cardiac Surgery

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