Hyperglucagonaemia in the surgical patient.

Russell, R. C. G.; Walker, Christopher J.; Bloom, S. R.

doi:10.1136/bmj.1.5948.10

Cited by 77 publications

(30 citation statements)

References 7 publications

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“…At both intervals of time, 6 hours and 48 hours, the serum cortisol level was significantly higher in the open group. [10][11][12] The systemic stress response is also mediated by inflammatory mediators originating from the surgical wounds. Of these mediators, IL-6 has a critical role in the induction and control of acute-phase protein synthesis, particularly of CRP, by human hepatocytes.…”

Section: Discussionmentioning

confidence: 99%

Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertiary care hospital, Bhuj, Gujarat, India: a prospective study

Kothari¹,

Rao²

2017

Int Surg J

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Background: Surgical trauma by incision and dissection of tissue stimulates the body to respond proportionately to the extent of injury. This study was conducted with an aim to compare metabolic and inflammatory responses after laparoscopic and open cholecystectomy namely serum cortisol and C-reactive protein levels before and after operation at Bhuj, Kutch, India.Methods: Present study was non-randomized, and comparative study carry out in the General Surgery Department at Gujarat Adani prospective institute of Medical Science, Bhuj, Kutch, Gujarat, India for an era of two years. One hundred and two patients were included in this study and were divided into two groups of open and laparoscopic cholecystectomy. Out of these 102 patients, 41 undergo open cholecystectomy and 61 laparoscopic cholecystectomy. Preoperative, intraoperative, postoperative and anesthetic medications were consistent in all the patients.Results: It was found that metabolic responses like serum cortisol were significantly higher after open procedure 6 hours and 48 hours postoperatively. Similarly, inflammatory response indicator C-reactive protein was raised significantly higher 48 hours after open as compared to laparoscopic cholecystectomy.Conclusions: Open cholecystectomy caused further tissue responses as compared to its laparoscopic alternative.

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Section: Discussionmentioning

confidence: 99%

Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertiary care hospital, Bhuj, Gujarat, India: a prospective study

Kothari¹,

Rao²

2017

Int Surg J

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“…Hyperglucagonemia occurs in a variety of catabolic conditions. These include trauma, burns, sepsis, cirrhosis, glucagonoma, the postoperative state, and poorly controlled type I diabetes (1)(2)(3)(4)(5). In patients with glucagonoma, in which glucose metabolism is only minimally disturbed, there is marked muscle wasting, skin atrophy, and hypoaminocidemia (6).…”

Section: Introductionmentioning

confidence: 99%

“…After isotope boluses had been administered and continuous infusion of l - [1][2][3][4][5][6][7][8][9][10][11][12][13] C]leucine at a rate of 7.5 mol/kg/h had begun, an infusion of normal saline at a rate of 1.5 ml/kg/h was initiated for the first 2 h of each study. After 2 h of each study, one of the following five infusion protocols was begun and continued for 4 h until completion of the study.…”

mentioning

confidence: 99%

Evidence for a catabolic role of glucagon during an amino acid load.

Charlton¹,

Adey²,

Nair³

1996

J. Clin. Invest.

108

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Despite the strong association between protein catabolic conditions and hyperglucagonemia, and enhanced glucagon secretion by amino acids (AA), glucagon's effects on protein metabolism remain less clear than on glucose metabolism. To clearly define glucagon's catabolic effect on protein metabolism during AA load, we studied the effects of glucagon on circulating AA and protein dynamics in six healthy subjects. Five protocols were performed in each subject using somatostatin to inhibit the secretion of insulin, glucagon, and growth hormone (GH) and selectively replacing these hormones in different protocols. Total AA concentration was the highest when glucagon, insulin, and GH were low. Selective increase of glucagon levels prevented this increment in AA. Addition of high levels of insulin and GH to high glucagon had no effect on total AA levels, although branched chain AA levels declined. Glucagon mostly decreased glucogenic AA and enhanced glucose production. Endogenous leucine flux, reflecting proteolysis, decreased while leucine oxidation increased in protocols where AA were infused and these changes were unaffected by the hormones. Nonoxidative leucine flux reflecting protein synthesis was stimulated by AA, but high glucagon attenuated this effect. Addition of GH and insulin partially reversed the inhibitory effect of glucagon on protein synthesis. We conclude that glucagon is the pivotal hormone in amino acid disposal during an AA load and, by reducing the availability of AA, glucagon inhibits protein synthesis stimulated by AA. These data provide further support for a catabolic role of glucagon at physiological concentrations. ( J. Clin. Invest. 1996. 98:90-99.)

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“…The invariant features of the metabolic stress response include release of the catabolic hormones epinephrine, norepinephrine, cortisol, glucagons, and growth hormone [11][12][13][14][15][16] and inhibition of insulin secretion and action. [17][18][19] Anti-Insulin Effects of Surgical Stress In addition to insulin resistance induced by circulating stress hormones, surgical stress has a deleterious effect on pancreatic ␤-cell function.…”

Section: From Research To Practice / Acute Care Of Patients With Diabmentioning

confidence: 99%

“…[11][12][13][14][15][16] The catecholamines (norepinephrine is augmented mostly during surgery and epinephrine postoperatively) stimulate gluconeogenesis and glycogenolysis, inhibit glucose utilization by peripheral tissues, and inhibit insulin secretion. 20 Activation of phosphoproteins by cAMP-dependent protein kinases accounts for the stimulatory effects of catecholamines on liver and muscle glycogen breakdown, whereas phosphorylation of glycogen synthase accounts for the decreased glycogen synthesis.…”

Section: Direct Catabolic Effects Of Stress Hormonesmentioning

confidence: 99%

Management of Diabetes Mellitus in Surgical Patients

Dagogo‐Jack¹,

Alberti²

2002

Diabetes Spectrum

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In Brief Diabetes is associated with increased requirement for surgical procedures and increased postoperative morbidity and mortality. The stress response to surgery and the resultant hyperglycemia, osmotic diuresis, and hypoinsulinemia can lead to perioperative ketoacidosis or hyperosmolar syndrome. Hyperglycemia impairs leukocyte function and wound healing. The management goal is to optimize metabolic control through close monitoring, adequate fluid and caloric repletion, and judicious use of insulin.

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Hyperglucagonaemia in the surgical patient.

Cited by 77 publications

References 7 publications

Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertiary care hospital, Bhuj, Gujarat, India: a prospective study

Assessment of different stress responses after laparoscopic and open cholecystectomy in patients attending tertiary care hospital, Bhuj, Gujarat, India: a prospective study

Evidence for a catabolic role of glucagon during an amino acid load.

Management of Diabetes Mellitus in Surgical Patients

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