Some Adrenal Facts and Fancies

Cl, Cope

doi:10.1177/003591576505800113

Cited by 11 publications

(2 citation statements)

References 12 publications

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“…Also, the postoperative plasma volume deficit was no larger in patients with an impaired adrenocortical response to surgery. Therefore, as an indication of absolute or relative (Cope, 1965) adrenocortical insufficiency, a reduced plasma volume does not seem to be an important factor contributing to hypotension in glucocorticoid-treated patients during surgery.…”

Section: Discussionmentioning

confidence: 97%

“…We have found previously a high incidence of arterial hypotension during operation in unsupplemented glucocorticoid-treated patients, which is not related to plasma cortisol concentrations (Kehlet and Binder, 1973b). However, it has been suggested (Cope, 1965) that during long-term glucocorticoid therapy the tissues become adapted to a higher glucocorticoid concentration, so that a decrease towards normal concentrations represents, relatively, a hypoadrenal state.…”

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confidence: 88%

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Plasma Volume During Surgery in Unsupplemented Glucocorticoid-Treated Patients

Kehlet

Engquist

Greibe

1974

British Journal of Anaesthesia

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Changes in plasma volume and plasma cortisol concentrations were investigated in seven unsupplemented and three supplemented glucocorticoid-treated patients and in eight control patients subjected to abdominal surgery. No differences in postoperative plasma volume deficit could be demonstrated between normal and glucocorticoidtreated patients, or between patients with a normal or an impaired adrenocortical response to surgery. These results may lend further support to observations indicating that arterial hypotension during operation in glucocorticoid-treated patients is not caused by adrenocortical insufficiency.

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 88%

Plasma Volume During Surgery in Unsupplemented Glucocorticoid-Treated Patients

Kehlet

Engquist

Greibe

1974

British Journal of Anaesthesia

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Control of Corticotrophin Secretion

Hodges¹,

Jones²,

Stockham³

1968

The Adrenocortical Hormones

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Pituitary-adrenal dynamics after ACTH-secreting pituitary tumor resection in patients receiving no steroids post-operatively

Pimentel-Filho

Silva

Nogueira

et al. 2005

J Endocrinol Invest

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It has recently been suggested that the classical routine of glucocorticoid administration before and after transsphenoidal surgery (TSS) in Cushing's disease (CD) patients may not be necessary, since it is likely that peritumoral normal corticotrophs are not completely suppressed during this period. We compared the dynamics of ACTH and cortisol from a group of CD patients (cured and not cured), receiving no steroids post-operatively, with a control group of acromegalic patients who presented normal hypothalamic-pituitary-adrenal (HPA) axis. Blood samples for ACTH and cortisol determination were obtained immediately before, at the end of surgery and at 4, 8, 12, 16, 24, 48 and 72 h after surgery, in 8 cured CD patients (Group I), 9 not cured CD patients (Group II) and in 7 subjects with acromegaly (Group III) who presented normal HPA axis (control group). The mean ACTH level in Group I was significantly lower than in Group III from 4 to 12 h and lower than in Group II from 8 to 12 h post-operatively. The mean cortisol level in Group I was lower than in Groups II and III from 8 to 72 h after surgery. No difference in mean cortisol level was observed among Groups II and III during the evaluated period. The lowest cortisol value in Group II was 193 nmol/l (at 24 h after surgery) and in Group I patients, after 20 h post-operatively, the highest cortisol level was 165 nmol/l. Although all cured CD patients (Group I) presented serum cortisol level lower than 55 nmol/l until 72 h after surgery, none had significant complications related to adrenal insufficiency. Ours findings are in agreement with recent observations that there is probably no need for glucocorticoid administration until clinical and/or laboratorial data are suggestive of adrenal insufficiency. However, we have also shown that a subphysiological HPA axis response could be observed in cured CD patients after TSS, and a definitive conclusion about glucocorticoid management during and after this procedure could not be made on the ground of the few cases studied in the literature.

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Some Adrenal Facts and Fancies

Cited by 11 publications

References 12 publications

Plasma Volume During Surgery in Unsupplemented Glucocorticoid-Treated Patients

Plasma Volume During Surgery in Unsupplemented Glucocorticoid-Treated Patients

Control of Corticotrophin Secretion

Pituitary-adrenal dynamics after ACTH-secreting pituitary tumor resection in patients receiving no steroids post-operatively

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