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

M. Heckmann; C. H. d’Uscio; H. Steckel; C. Neuhaeuser; R.-H. Bödeker; J. Thul; D. Schranz; B. M. Frey

doi:10.1055/s-0034-1375650

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2014; 46(10): 677-684
DOI: 10.1055/s-0034-1375650

Endocrine Care

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

M. Heckmann

¹Departments of General Pediatrics & Neonatology, Justus Liebig University, Giessen, Germany

²Present address: Department of Neonatology and Pediatric Intensive Care, Ernst-Moritz-Arndt-University Greifswald, Greifswald, Germany

,

C. H. d’Uscio

³Departments of Nephrology & Hypertension, University Hospital Bern, Bern, Switzerland

,

H. Steckel

¹Departments of General Pediatrics & Neonatology, Justus Liebig University, Giessen, Germany

,

C. Neuhaeuser

¹Departments of General Pediatrics & Neonatology, Justus Liebig University, Giessen, Germany

⁴Soins intensifs pédiatriques, Clinique pédiatrique, Centre Hospitalier de Luxembourg

,

R.-H. Bödeker

⁵Institute of Medical Statistics, Justus Liebig University, Giessen, Germany

,

J. Thul

⁶Department of Pediatric Cardiology, Justus Liebig University, Giessen, Germany

,

D. Schranz

⁶Department of Pediatric Cardiology, Justus Liebig University, Giessen, Germany

,

B. M. Frey

³Departments of Nephrology & Hypertension, University Hospital Bern, Bern, Switzerland

⁷Clinical Research, University Hospital Bern, Bern, Switzerland

› Author Affiliations

Abstract

We examined the hypothesis that major cardiac surgery triggers a more intense adrenal stress response than less intensive noncardiac surgery, which then alters cortisol inactivation. Urinary excretion rates of glucocorticoid metabolites were determined before and after surgery using gas chromatography-mass spectrometry in 29 children undergoing scheduled major cardiac surgery and 17 control children undergoing conventional noncardiac surgery in a prospective observational study. Excretion rates of glucocorticoid metabolites were summed and corrected for creatinine excretion to calculate cortisol production rates (mg/mmol creatinine/m² body surface area). Precursor/product ratios from individual metabolites were calculated to characterize cortisol inactivation (11β-hydroxysteroid dehydrogenase). Postoperatively, median cortisol production rates increased in both groups (MCS: from 2.7 to 9.3; controls: from 2.7 to 5.8; p<0.001) with no significant difference between groups (p=0.12). Ratios of cortisol to cortisone metabolites, indicating the overall activity of 11β-hydroxysteroid dehydrogenase, increased postoperatively in both groups (p<0.001). In conclusion, surgery resulted in a distinct postoperative increase in cortisol production. In contrast to our hypothesis, children undergoing major cardiac surgery did not show an increased adrenal stress response compared to children undergoing conventional surgery. Furthermore, the reduction in cortisol inactivation appears to be an essential part of the stress response to pediatric surgery in general.

Key words

11β-hydroxysteroid dehydrogenase - glucocorticoid - precursor/product ratio

Full Text

References

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