The Evaluation of Postoperative Function of the Adrenal Gland

Jl, Mohler; Ka, Michael; Am, Freedman; Jw, McRoberts; Wo, Griffen

doi:10.1097/00132586-198612000-00037

Cited by 7 publications

(4 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[54][55][56] Total adrenal insufficiency is also rare in severely ill patients, occurring in 2 to 3 percent of patients. 3,5,57 However, the notion of total adrenal insufficiency has been gradually replaced by the concept of occult or relative adrenal insufficiency, caused by preexisting disease, concomitant factors, or complications that only partially reduce the adrenocortical capacity to produce cortisol (Table 1).…”

Section: The Normal Response Of the Hypothalamic-pituitary-adrenal Axmentioning

confidence: 99%

Corticosteroid Therapy in Severe Illness

1997

View full text Add to dashboard Cite

Section: The Normal Response Of the Hypothalamic-pituitary-adrenal Axmentioning

confidence: 99%

Corticosteroid Therapy in Severe Illness

1997

View full text Add to dashboard Cite

“…The quantitative rise in postoperative cortisol levels correlates with the extent of surgery and the illness severity scores (10). A relative deficiency of the cortisol stress response can cause hemodynamic abnormalities that mimic hypovolemic or septic shock and may contribute to a fatal outcome (1).…”

Section: Introductionmentioning

confidence: 99%

Adrenal function during coronary artery bypass grafting

Henzen

Kobza²,

Schwaller-Protzmann³

et al. 2003

European Journal of Endocrinology

View full text Add to dashboard Cite

Objective: To assess adrenal function in patients undergoing coronary artery bypass grafting (CABG) by means of the low-dose (1 mg) ACTH test, and to correlate the adrenal function with clinical outcome. Methods: During a 5-month period we prospectively included 45 patients undergoing elective CABG with cardiopulmonary bypass and without symptoms of endocrine disease. Low-dose (1 mg) ACTH tests were performed on the day before surgery (day 21), immediately after the operation (day 0), on the two subsequent days in the intensive care unit (day 1 and day 2), and on the day of discharge from the hospital. A number of clinical, hemodynamic and laboratory parameters were monitored throughout. Results: On day 2 1, 75% of the study patients had normal stimulated plasma cortisol concentrations. Eleven patients (25%) had an impaired adrenal response to 1 mg ACTH. The stimulated plasma cortisol concentrations in patients who had an inadequate adrenal response on day 2 1 remained significantly reduced on day 1 (756^205 vs 949^259 nmol/l, P ¼ 0.03) (mean^S.D.), day 2 (644 (580 -793) vs 885 (713-1087), P ¼ 0.03) (median (interquartile range)), and on the day of discharge (698^201 vs 854^186, P ¼ 0.05). In patients with a normal adrenal response in the preoperative setting peak cortisol concentrations were reached on day 1, in patients with a blunted adrenal response they were reached on day 2. There were significant correlations between the stimulated plasma cortisol concentrations and the blood loss (r ¼ 2 0.50, P ¼ 0.002) and volume balance (r ¼ 0.41, P ¼ 0.015). Conclusions: Occult (partial) adrenal insufficiency is common in patients undergoing CABG who are otherwise asymptomatic as regards endocrine disease. The adrenal function in these patients differs both in the magnitude of cortisol response to ACTH and in the time course, with significantly delayed peak cortisol concentrations. Adequate regulation of volume balance and the amount of blood loss seem to correlate with adequacy of adrenal function.

show abstract

“…Relative adrenal insufficiency (RAI) is an uncommon clinical condition that can develop after conventional surgery, with an incidence of approximately 0.5% 1, 2. Previous studies have shown that RAI occurs more frequently in critically ill patients with severe infection, trauma, or aggressive surgery 3, 4.…”

mentioning

confidence: 99%

Prevalence and risk factors for delayed adrenal insufficiency after liver transplantation

et al. 2008

View full text Add to dashboard Cite

Liver transplantation (LT) recipients are at risk for early and delayed adrenal insufficiency for multiple reasons. Although early adrenal insufficiency is known to occur in a high proportion of recipients maintained on steroid-free immunosuppressive regimens, the prevalence and risk factors associated with delayed functional adrenal gland atrophy (FAGA) are unknown because routine evaluation for this condition is not standard practice among LT centers. We investigated a group of 87 patients (64 males) transplanted for end-stage liver disease related to different etiologies. All underwent a standard corticotropin stimulation test (CST) when, after gradual steroid tapering, they had been maintained for at least 1 week on oral prednisone at a daily dose of 5 mg. FAGA, defined by a serum cortisol concentration that, 60 minutes after corticotropin administration, did not double the baseline level and remained Ͻ20 g/dL, was diagnosed in 23/87 patients (26.4%). Stepwise logistic regression analysis selected as significant predictors of FAGA the cumulative dosage of corticosteroids administered (P Ͻ 0.01), the increase in the body mass index after LT (P Ͻ 0.01), a low serum cholesterol concentration (P ϭ 0.005), and a high adrenocorticotropin hormone (ACTH) serum level (P Ͻ 0.05) at the time CST was performed. In conclusion, FAGA is a common condition among LT recipients who are maintained on prolonged corticosteroid immunosuppressive treatment. Relative adrenal insufficiency (RAI) is an uncommon clinical condition that can develop after conventional surgery, with an incidence of approximately 0.5%. 1,2 Previous studies have shown that RAI occurs more frequently in critically ill patients with severe infection, trauma, or aggressive surgery. 3,4 Moreover, RAI has been recently described in patients with end-stage liver disease, a setting for which the definition of hepatoadrenal syndrome has been proposed. 5 Although the mechanisms responsible for RAI in patients with advanced liver diseases have not been fully elucidated, decreased availability of cholesterol 6 and high levels of endotoxin and proinflammatory cytokines, such as tumor necrosis factor alpha, 7,8 may play a major role.Factors able to induce an adrenal crisis, such as hypotension, infection, and severe blood loss, may all complicate liver transplantation (LT) in the early postoperative period. Glucocorticoids, included in the majority of immunosuppressive protocols adopted after LT, prevent LT recipients from developing early RAI after LT but greatly increase the risk of late functional adrenal gland atrophy (FAGA). Indeed, the prolonged use of corticosteroids is a major cause of adrenal suppression, and corticosteroid discontinuation can therefore trigger overt FAGA. 9 LT recipients are therefore at risk for adrenal insufficiency in their first year after the transplant operation for multiple reasons. However, routine evaluation for this condition is not standard Abbreviations: ACTH, adrenocorticotropin hormone; BMI, body mass index; CI, confidence inter...

show abstract

The Evaluation of Postoperative Function of the Adrenal Gland

Cited by 7 publications

References 0 publications

Corticosteroid Therapy in Severe Illness

Corticosteroid Therapy in Severe Illness

Adrenal function during coronary artery bypass grafting

Prevalence and risk factors for delayed adrenal insufficiency after liver transplantation

Contact Info

Product

Resources

About