Serum steroids and prolactin during and after major surgical trauma

Abstract

Serum levels of cortisol, dehydroepiandrosterone (DHA) and its sulfate (DHAS), 4-androstene-3,17-dione (A-4), 17-alfa-hydroxy-progesterone (17 OHP), testosterone (T, only in males), unconjugated (E1) and total estrone (tE1 greater than 85% estrone sulfate) were studied in six male and two female patients before, during and up to 30 days after aortic graft surgery. All steroids except 17 OHP decreased following induction of anesthesia but, except for testosterone, rose again during surgery to preoperative levels or slightly above. Extremely high peak values for E1 and tE1 and a less pronounced peak for cortisol were noted on postoperative day 2; after that, the levels of these steroids returned to normal. The levels of 17-OHP, DHA and DHAS decreased after surgery and were below preoperative values from postoperative day 4 to day 16 or (DHAS) day 30. In males, 17 OHP showed a pronounced peak 30 min after initiation of surgery, but decreased after that to below preoperative values. Testosterone levels decreased further during surgery and remained very low until postoperative day 16. Major surgical trauma has a rapid, profound and long-lasting effect on gonadal activity, as judged from decreased testosterone levels, while the effect on adrenal steroids is less pronounced. Adrenal delta 4 and delta 5-steroids showed different patterns in the postoperative period, indicating differences in their regulation. The highly elevated estrogen levels on postoperative day 2 probably reflect either transiently elevated peripheral aromatization or decreased estrogen metabolism rather than increased levels of substrate steroids (A-4). The biological significance of this remains to be elucidated.

Expression of p21(WAF1/CIP1/SDI1) and p53 in apoptotic cells in the adrenal cortex and induction by ischemia/reperfusion injury.

“…However, milder forms of this process, not associated with overt adrenal failure and glucocorticoid deficiency, are increasingly recognized as a consequence of the more frequent use of MRI and CT scanning (66). The less severe reaction of the adrenal cortex to surgical stress commonly involves a selective decrease in the production of adrenal androgen precursors (67). These steroids are synthesized by cells on the venous end of the capillary bed, the zona reticularis, and so might be particularly susceptible to ischemic injury (68).…”

Nutritional status and the gonadotrophic response to a polar expedition

“…Acute physiological stress, such as that associated with surgery (Lindh et al 1992), burns (Lephart et al 1987), severe illness (Semple et al 1980) or completing an ultraendurance event (Tauler et al 2014) are well recognised causes of a rapid reduction in testosterone. Similarly, arduous physical training may also affect the hypothalamicpituitary-testicular axis (Gomez-Merino et al 2003, Alemany et al 2008, with testosterone reported to decrease by 50-60% during United States Ranger and Marine training (Friedl et al 2000, Alemany et al 2008.…”

Longitudinal Study of Adrenocortical Function following Allogeneic Bone Marrow Transplantation in Children

“…An abnormal adrenocortical ste roid pattern similar to that found in the TBI-treated patients, with low adrenal androgen and normal or even elevated cortisol levels, has previously been found in some other pathological conditions, e.g. after surgical stress, during chronic illness and during physical stress [7,[19][20][21], The reason for these changes as well as for the normal age-related changes in healthy subjects is not known. One may speculate about a redistribution of the adrenocortical steroid flux in order to maintain an ade quate cortisol secretion [7], As shown in table 1 the leukemia patients were very heterogeneous concerning age at the time of diagnosis and the amounts of cytostatic drugs received before BMT.…”