The Effect of Surgical Operation on the Plasma Clearance of Infused Cortisol

Murray, James O. S.; Marks, Leon J.; Colombo, Frank V.; Josephs, Burrill N.; Leftin, Jehaudah H.; Leonard, Marcia P.

doi:10.1097/00000658-195812000-00013

Cited by 18 publications

(2 citation statements)

References 13 publications

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“…Conflicting evidence has been presented as to whether conjugated steroids actually rise in the few hours after surgery (5, 7). All authors (5,7,21) are agreed that free cortisol increases and is not handled in a normal manner by the liver, under the "stress" of surgery. Other studies (22)(23)(24) document the increase of plasma 17-hydroxycorticosteroids in other "stressful" situations in animals as well as in man.…”

Section: Discussionmentioning

confidence: 99%

Acth Levels in Plasma in Preoperative and Surgically Stressed Patients*

Cooper

Nelson²

1962

J. Clin. Invest.

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ACTH levels in human plasma during surgical stress have not been estimated previously. Much evidence (1-7) has accumulated, however, concerning variations in adrenal cortical steroids in plasma during and after surgery. Although an increase in plasma ACTH with stress has been noted in animal experiments, it has been suggested by some investigators that elevation of corticosteroids in plasma after surgery is controlled by changes in hepatic function and concentration of plasma corticosteroid rather than by a "direct drive" of ACTH release (8, 9).

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Section: Discussionmentioning

confidence: 99%

Acth Levels in Plasma in Preoperative and Surgically Stressed Patients*

Cooper

Nelson²

1962

J. Clin. Invest.

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“…While the increased plasma levels of 17-hydroxycorticosteroids, so frequently reported, on the day of surgery are perhaps in part due to decreased plasma clearance of these substances (63)(64)(65)(66), it would be unlikely that diminished plasma clearance would account for significant plasma levels by the second postoperative day (67). Furthermore, the effect of hydrocorticosterone is not clearly that of producing increased tubular reabsorption of sodium, and in fact under certain circumstances there is evidence to suggest that such hormones may actually produce increased sodium excretion (68).…”

Section: Discussionmentioning

confidence: 99%

Mechanism of Postoperative Limitation in Sodium Excretion: The Role of Extracellular Fluid Volume and of Adrenal Cortical Activity1

Randall¹,

Papper²

1958

J. Clin. Invest.

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Decreased renal excretion of sodium is a wellknown feature of the immediate postoperative state (1-3). The mechanisms responsible have, however, not been clearly defined. While increased adrenal cortical secretion such as is generally associated with major surgical procedures (4-9) has been causally implicated by many investigators (1,3,(10)(11)(12)(13), there is considerable evidence that the changes in sodium excretion are independent of variations in the supply of adrenal cortical hormones (14-18).The extracellular fluid volume, or more precisely that portion of it which is physiologically "effective," has been shown to be a major determinant of renal sodium excretion in normal individuals (19-21). Therefore variation in this volume warrants consideration as a possible etiological factor in the decreased postoperative excretion of sodium. The observations that fluid sequestration occurs in and about the traumatized tissues both in animals and in man indeed suggests that a dislocation of the body fluids may occur in the surgical patient and result in a contraction of the effective extracellular fluid volume.The present study was designed to investigate the effect of isotonic expansion of the extracellular fluid volume on the postoperative response to the administration of sodium chloride. The data indicate that the usually observed impairment in natriuretic response is corrected by isotonic extracellular fluid volume expansion. In addition, studies in a patient with Addison's disease suggest that decreased natriuresis postoperatively occurs independently of enhanced adrenal cortical hormone secretion.1 An abstract of this paper appeared in the J. clin. Invest. 1958, 37, 923. 2 Present address: Travis Air Force Base, Calif. METHODSFive young males without cardiovascular, renal, hepatic or endocrine disease were studied before and after orthopedic surgical procedures of sufficient extent to produce major surgical trauma (Table I). One patient (No. 3, A and B) was studied before and after two Moore arthroplasties performed five weeks apart. Orthopedic patients were chosen for study in order to avoid the complicating factors of major gastrointestinal losses of fluids and electrolytes and to allow continued oral intake in the postoperative period. Commencing on the fifth or sixth day before surgery and continuing through the third postoperative day the patients were provided a daily diet containing approximately 43 mEq. of sodium and in addition received nonenteric coated sodium chloride tablets four times daily so that the total sodium intake was 197 mEq. per day. On the day of surgery sufficient isotonic saline solution was given intravenously to maintain the total intake, including the sodium content of the citrated blood, at 197 mEq. Blood loss during surgery was replaced so that in no instance was significant hypotension observed. Oral intake of fluid and food was usually re-instituted by evening of the day of surgery. The daily intake of fluids was recorded in five studies and it was possible to weigh three...

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