Reduction in Cortisol Inactivation is Part of the Adrenal Stress Response to Cardiac and Noncardiac Pediatric Surgery: A Prospective Study Using Gas Chromatography-Mass Spectrometry Analysis

Insufficient adrenal function in preterm infants affects poor neonatal outcome, owing to the immaturity of their adrenal enzyme. While 11β-hydroxysteroid dehydrogenase (11βHSD) type 1 and type2 act as gatekeepers for cell steroid action. This study aimed to investigate the effects of early postnatal urinary tetrahydrocortisol/tetrahydrocortisone (F/E) ratio, used as an alternative indicator of 11βHSDs activity, in preterm infants on their subsequent clinical course. In 80 preterm infants of ≤ 34 weeks gestational age admitted to our hospital, urinary F/E ratio was measured within 24 hours of birth. Furthermore, the relationship between this ratio and neonatal outcomes was estimated. Univariate analysis revealed that the high F/E ratio group had significantly higher morbidity in terms of duration of ventilatory support for more than 14 days, hypotension requiring inotropes and hydrocortisone, and symptomatic patent ductus arteriosus. On multivariate analysis, the incidence of hypotension requiring hydrocortisone was higher in the high F/E group, despite the absence of elevated dehydroepiandrosterone, a precursor of cortisol.Conclusion: The urinary F/E ratio in the early postnatal period in preterm infants may contribute to the understanding of the pathogenesis of infant condition after birth by estimating the amount of local steroid action in the organs.

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“…Heckmann et al reported similar actions in cardiac paediatric surgery. Our results are in agreement with that of these studies [24].…”

Section: Discussionsupporting

confidence: 94%

Urinary Tetrahydrocortisol/Tetrahydrocortisone Ratio at Early Postnatal Period Predict Steroid Dependency and Neonatal Condition in Preterm Infant

Nagaya

Okamoto

Nohara

et al. 2021

Preprint

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“…This could suggest an alteration of the activity of the 11β-Hydroxysteroid dehydrogenase (11ß-HSD) system. Several studies have demonstrated a similar increase in the cortisol to cortisone ratios in the days after cardiac surgery [19][20][21]. It is unclear if the 11ß-HSD isoenzyme type 2 that inactivates cortisol to cortisone is blocked or saturated by substrate overload or/and there is an activation of the 11ß-HSD isoenzyme type 1 that regenerates cortisol from cortisone.…”

Section: Discussionmentioning

confidence: 96%

The Peacock study: feasibility of the dynamic characterisation of the paediatric hypothalamic-pituitary-adrenal function during and after cardiac surgery

Fudulu

Angelini

Papadopoulou

et al. 2020

BMC Cardiovasc Disord

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Background: Cortisol is the main stress hormone mobilised during surgery to establish homeostasis. Our current understanding of the hypothalamic-pituitary-adrenal axis physiology in children undergoing cardiopulmonary bypass is very limited due to: (1) very few cortisol time point measurements over long periods (2) difficulties of sampling in low weight babies and (3) the concomitant use of glucocorticoids at anaesthesia induction. This lack of understanding is reflected in a lack of consensus on the utility of glucocorticoids perioperatively in cardiac surgery with the use of cardiopulmonary bypass. Methods: The Peacock Study is a prospective, two-centre, observational cohort study of 78 children (undergoing cardiopulmonary bypass procedures and non-surgical procedures-split by age/cyanosis) that aims to characterise in detail the hypothalamic-pituitary-adrenal axis physiology of children using the stress model of paediatric cardiac surgery. Also, we aim to correlate cortisol profiles with clinical outcome data. We herein describe the main study design and report the full cortisol profile of one child undergoing heart surgery, thus proving the feasibility of the method. Results: We used an automated, 24-h tissue microdialysis system to measure cortisol and cortisone, every 20 min. We herein report one cortisol profile of a child undergoing heart surgery. Besides, we measured serum cortisol and adrenocorticotrophic hormone at seven-time points for correlation. Tissue concentrations of cortisol increased markedly several hours after the end of surgery. We also noted an increase in the tissue cortisol/cortisone ratio during this response.

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“…Nowadays, there are highly accurate and advanced instrumental analysis methods for accurate measurement of cortisol in biological fluids, such as ELISA-based immunoassay techniques that are portable devices, unlike liquid and gas chromatography [ 13 , 14 ]. Cortisol ELISA assay kits are currently the most common commercial kits that can measure cortisol in saliva, urine, serum, and plasma with acceptable sensitivity to the minimum required volume of a real sample [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

A Novel Electrochemical Aptasensor Based on a New Platform of Samarium Molybdate Flower-like Nanoparticles@Poly(pyrrole) for Non-Invasive Determination of Saliva CORTISOL

2022

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Cortisol, a famous stress biomarker, can be considered a potential predictor of cardiac diseases in humans. The presence of cortisol in saliva has encouraged researchers to design point-of-care devices for cortisol concentration in biological fluids. Here, human salivary cortisol was analyzed through a new non-invasive voltammetric aptasensor. Although cortisol is an electroactive compound, generally, the reduction in the current peak has been considered; however, this does not show a strong signal on a bare electrode surface, especially at low concentration levels. Hence, in this study, cortisol concentration was measured electrochemically and indirectly by monitoring the difference between electrochemical probe signals in the presence and absence of cortisol. A new polymeric nanocomposite of samarium molybdate flower-like nanoparticles decorated in poly(pyrrole) was electro-synthesized on the surface of a glassy carbon electrode. Then, reduced graphene oxide was cast on the surface. Finally, the cortisol aptamer was immobilized covalently on the reduced graphene oxide. This platform was used to increase the oxidation current peak of the ferricyanide solution as a probe as well as its electrocatalyst. The novel designed polymeric has the potential ability for effective immobilization of aptamers on the electrode surface without decreasing their biological activities. Additionally, it can enhance the probe electrochemical signal. The differential pulse voltammetric method (DPV) was applied as the detection technique. By optimizing the effective parameters, a determination range of 5.0 × 10−14–1.5 × 10−11 mol/L and a limit of detection of 4.5 × 10−14 mol/L were obtained. Selectivity of the proposed aptasensor relative to β-estradiol, progesterone and also prednisolone was studied as well. Finally, cortisol in a healthy human saliva sample was successfully analyzed by the proposed biosensors.

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Reduction in Cortisol Inactivation is Part of the Adrenal Stress Response to Cardiac and Noncardiac Pediatric Surgery: A Prospective Study Using Gas Chromatography-Mass Spectrometry Analysis

Cited by 7 publications

References 20 publications

Urinary Tetrahydrocortisol/Tetrahydrocortisone Ratio at Early Postnatal Period Predict Steroid Dependency and Neonatal Condition in Preterm Infant

Urinary Tetrahydrocortisol/Tetrahydrocortisone Ratio at Early Postnatal Period Predict Steroid Dependency and Neonatal Condition in Preterm Infant

The Peacock study: feasibility of the dynamic characterisation of the paediatric hypothalamic-pituitary-adrenal function during and after cardiac surgery

A Novel Electrochemical Aptasensor Based on a New Platform of Samarium Molybdate Flower-like Nanoparticles@Poly(pyrrole) for Non-Invasive Determination of Saliva CORTISOL

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