Hormonal Responses to Graded Surgical Stress

Chernow, Bart; Alexander, H. Richard; Smallridge, Robert C.; Thompson, William R.; Cook, David; Beardsley, David; Fink, Mitchell P.; Lake, C. Raymond; Fletcher, J. R.

doi:10.1001/archinte.1987.00370070087013

Cited by 392 publications

(71 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The cortisol response to medical emergencies seems to be proportional to the severity of illness. It can be presumed that the adrenal response is usually appropriate and maximal in life threatening conditions (3,4,33). According to a new concept of cortisol homeostasis in critical illness, ACTH is not elevated, even suppressed due to the high cortisol level.…”

Section: Discussionmentioning

confidence: 99%

“…Since then, it is universally accepted that stress is associated with elevated cortisol levels. Later human studies demonstrated the connection between the severity of stress and the magnitude of adrenocortical response (3,4). The term 'relative adrenal insufficiency' (RAI) was introduced earlier and applied to critically ill patient populations (5,6,7,8,9,10,11,12,13,14).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study

Tarjanyi

Montskó

Kenyeres

et al. 2014

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: The role of cortisol in the prediction of mortality risk in critical illness is controversial in the literature. The aim of this study was to evaluate the prognostic value of cortisol concentrations in a mixed population of critically ill patients in medical emergencies. Design: In this prospective, observational study, measurement of total (TC) and free cortisol (FC) levels was made in the serum samples of 69 critically ill patients (39 males and 30 females, median age of 74 years) at admission (0 h) and 6, 24, 48, and 96 h after admission. Methods: Cortisol levels were determined using HPLC coupled high-resolution ESI-TOF mass spectrometry. The severity of disease was calculated by prognostic scores. Statistical analyses were performed using the SPSS 22.0 software. Results: The range of TC varied between 49.9 and 8797.8 nmol/l, FC between 0.4 and 759.9 nmol/l. The levels of FC at 0, 6, 24, and 48 h and TC at 0, 6 h were significantly elevated in non-survivors and correlated with the predicted mortality. The prognostic value of these cortisol levels was comparable with the routinely used mortality scores. In predictive models, FC at 6, 24, and 48 h proved to be an independent determinant of mortality. Conclusions:The predictive values of FC in the first 2 days after admission and TC within 6 h are comparable with the complex, routinely used mortality scores in evaluating the prognosis of critically ill patients. The cortisol response probably reflects the severity of disease.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study

Tarjanyi

Montskó

Kenyeres

et al. 2014

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…Brain, nerve, retina, ovary, placenta, lung, artery, and cervix tissues are rich in tissue factor and therefore especially vulnerable to both primary malignancy and metastasis [210,552,556,557,[598][599][600]. SRM activity thus explains the close association of malignancy with chronic disease, environmental stress, inflammation, elevated Factor VII and Factor VIII activity, increased blood viscosity and coagulability, accelerated atherosclerosis, and seemingly unrelated forms of malignancy [556][557][558]566,[601][602][603][604][605].…”

Section: Inflammation Apoptosis and Malignancymentioning

confidence: 99%

Stress repair mechanism activity explains inflammation and apoptosis

Coleman¹

2012

ABB

View full text Add to dashboard Cite

“…None of these treatment modalities restore the acute cortisol response to stress needed to maintain circulation and energy homeostasis. Depending on severity and duration of the stressful event, serum cortisol levels rise to 500-1430 nmol/l (or 18-52 mg/dl) (6), which provide the basis for the recommendation to double or triple the daily dosage during acute stress and illness (7).…”

Section: Introductionmentioning

confidence: 99%

“…Minor stress also normally increases the level of cortisol (6). Many patients regularly increase their dosage during physical exercise or emotional stress.…”

Section: Introductionmentioning

confidence: 99%

Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure

Šimůnková

Jovanovic²,

Rostrup³

et al. 2016

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: Many patients with primary adrenal insufficiency (Addison's disease) take extra doses of glucocorticoids during stressful events, but a benefit has not been demonstrated in controlled trials. Here, we investigated the effects of a pre-exercise hydrocortisone dose on cardiorespiratory, hormonal and metabolic parameters in response to short-term strenuous physical activity. Design: This was a randomized placebo-controlled, cross-over clinical trial. Participants: Ten women with Addison's disease and 10 age-matched healthy females participated in the study. Measurements: All women in the study underwent maximal incremental exercise testing. A stress dose of 10 mg hydrocortisone or placebo was given 1 h prior to exercise on two occasions. Blood samples were drawn before, and 0, 15 and 30 min post exercise. Oxygen uptake, maximal aerobic capacity, endocrine and metabolic responses to physical activity, as well as health status by questionnaires were evaluated. Results: Maximal aerobic capacity and duration of exercise were significantly lower in patients than in healthy subjects and did not improve with the treatment. After an extra hydrocortisone dose serum cortisol was significantly higher than in the healthy subjects (P!0.001). Post-exercise glucose and adrenaline levels were significantly lower and free fatty acids insignificantly higher in patients irrespective of stress dose. Stress dosing did not alter other metabolic or hormonal parameters or quality of life after the exercise. Conclusions: The patients did not benefit from an extra dose of hydrocortisone in short strenuous exercise. Stress dosing may not be justified in this setting. Whether stress dosing is beneficial in other types of physical activity will have to be examined further.

show abstract

Hormonal Responses to Graded Surgical Stress

Cited by 392 publications

References 47 publications

Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study

Free and total cortisol levels are useful prognostic markers in critically ill patients: a prospective observational study

Stress repair mechanism activity explains inflammation and apoptosis

Effect of a pre-exercise hydrocortisone dose on short-term physical performance in female patients with primary adrenal failure

Contact Info

Product

Resources

About