Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Miguel Debono; Lorcan Sheppard; Sarah Irving; Philip Jackson; Jo Butterworth; Zoe L.S. Brookes; John Newell-Price; JJ Ross; RJ Ross

doi:10.1530/eje-10-0996

Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Miguel Debono, Lorcan Sheppard, Sarah Irving, Philip Jackson, Jo Butterworth, Zoe L.S. Brookes, John Newell-Price, JJ Ross, RJ Ross

Peninsula Dental School

Research output: Contribution to journal › Article › peer-review

Abstract

ObjectivePatients with cortisol deficiency poorly tolerate any systemic inflammatory response syndrome (SIRS), and may die if not treated with sufficient exogenous glucocorticoids. Controversy surrounds what constitutes a ‘normal’ adrenal response in critical illness. This study uses conventional tests for adrenal insufficiency to investigate cortisol status in patients undergoing elective coronary artery bypass surgery, a condition frequently associated with SIRS.DesignA prospective, observational study.MethodsThirty patients with impaired left ventricular function (ejection fraction >23% <50%) underwent basal ACTH measurement, and a short cosyntropin test (250 μg, i.v.) 1 week preoperatively, and at +4 h following induction of general anaesthesia. Preoperatively, a 30 min cortisol level post cosyntropin >550 nmol/l was taken as a normal response.ResultsPrior to surgery, all patients had a normal response to cosyntropin. Postoperatively, eight patients (26.7%) did not achieve stimulated cortisol levels >550 nmol/l and the mean peak cortisol postoperatively was lower (1048 vs 730 nmol/l; P<0.001). There was a significant rise in ACTH after surgery (21 vs 184 ng/l; P=0.007) and reduction in Δ-cortisol post cosyntropin (579 vs 229 nmol/l; P<0.001). There was no change in basal cortisol pre- and post-operatively (447 vs 501; P=0.4). All patients underwent routine, uneventful postoperative recovery.ConclusionUp to one quarter of patients with a normal cortisol status preoperatively demonstrated a raised ACTH and deficient cortisol response postoperatively. Despite these responses, all patients had uneventful outcomes. These data reinforce the need for caution when interpreting results of endocrine testing following major surgery or in the intensive care environment, and that prognostic value of these results may be of limited use.

Original language	English
Pages (from-to)	413-419
Number of pages	0
Journal	European Journal of Endocrinology
Volume	164
Issue number	3
DOIs	https://doi.org/10.1530/eje-10-0996
Publication status	Published - Mar 2011

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1530/eje-10-0996

Cite this

@article{8634c371acbf473eb22c796fd15354bb,

title = "Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery",

abstract = "ObjectivePatients with cortisol deficiency poorly tolerate any systemic inflammatory response syndrome (SIRS), and may die if not treated with sufficient exogenous glucocorticoids. Controversy surrounds what constitutes a {\textquoteleft}normal{\textquoteright} adrenal response in critical illness. This study uses conventional tests for adrenal insufficiency to investigate cortisol status in patients undergoing elective coronary artery bypass surgery, a condition frequently associated with SIRS.DesignA prospective, observational study.MethodsThirty patients with impaired left ventricular function (ejection fraction >23% <50%) underwent basal ACTH measurement, and a short cosyntropin test (250 μg, i.v.) 1 week preoperatively, and at +4 h following induction of general anaesthesia. Preoperatively, a 30 min cortisol level post cosyntropin >550 nmol/l was taken as a normal response.ResultsPrior to surgery, all patients had a normal response to cosyntropin. Postoperatively, eight patients (26.7%) did not achieve stimulated cortisol levels >550 nmol/l and the mean peak cortisol postoperatively was lower (1048 vs 730 nmol/l; P<0.001). There was a significant rise in ACTH after surgery (21 vs 184 ng/l; P=0.007) and reduction in Δ-cortisol post cosyntropin (579 vs 229 nmol/l; P<0.001). There was no change in basal cortisol pre- and post-operatively (447 vs 501; P=0.4). All patients underwent routine, uneventful postoperative recovery.ConclusionUp to one quarter of patients with a normal cortisol status preoperatively demonstrated a raised ACTH and deficient cortisol response postoperatively. Despite these responses, all patients had uneventful outcomes. These data reinforce the need for caution when interpreting results of endocrine testing following major surgery or in the intensive care environment, and that prognostic value of these results may be of limited use.",

author = "Miguel Debono and Lorcan Sheppard and Sarah Irving and Philip Jackson and Jo Butterworth and Brookes, {Zoe L.S.} and John Newell-Price and JJ Ross and RJ Ross",

year = "2011",

month = mar,

doi = "10.1530/eje-10-0996",

language = "English",

volume = "164",

pages = "413--419",

journal = "European Journal of Endocrinology",

issn = "0804-4643",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

AU - Debono, Miguel

AU - Sheppard, Lorcan

AU - Irving, Sarah

AU - Jackson, Philip

AU - Butterworth, Jo

AU - Brookes, Zoe L.S.

AU - Newell-Price, John

AU - Ross, JJ

AU - Ross, RJ

PY - 2011/3

Y1 - 2011/3

N2 - ObjectivePatients with cortisol deficiency poorly tolerate any systemic inflammatory response syndrome (SIRS), and may die if not treated with sufficient exogenous glucocorticoids. Controversy surrounds what constitutes a ‘normal’ adrenal response in critical illness. This study uses conventional tests for adrenal insufficiency to investigate cortisol status in patients undergoing elective coronary artery bypass surgery, a condition frequently associated with SIRS.DesignA prospective, observational study.MethodsThirty patients with impaired left ventricular function (ejection fraction >23% <50%) underwent basal ACTH measurement, and a short cosyntropin test (250 μg, i.v.) 1 week preoperatively, and at +4 h following induction of general anaesthesia. Preoperatively, a 30 min cortisol level post cosyntropin >550 nmol/l was taken as a normal response.ResultsPrior to surgery, all patients had a normal response to cosyntropin. Postoperatively, eight patients (26.7%) did not achieve stimulated cortisol levels >550 nmol/l and the mean peak cortisol postoperatively was lower (1048 vs 730 nmol/l; P<0.001). There was a significant rise in ACTH after surgery (21 vs 184 ng/l; P=0.007) and reduction in Δ-cortisol post cosyntropin (579 vs 229 nmol/l; P<0.001). There was no change in basal cortisol pre- and post-operatively (447 vs 501; P=0.4). All patients underwent routine, uneventful postoperative recovery.ConclusionUp to one quarter of patients with a normal cortisol status preoperatively demonstrated a raised ACTH and deficient cortisol response postoperatively. Despite these responses, all patients had uneventful outcomes. These data reinforce the need for caution when interpreting results of endocrine testing following major surgery or in the intensive care environment, and that prognostic value of these results may be of limited use.

AB - ObjectivePatients with cortisol deficiency poorly tolerate any systemic inflammatory response syndrome (SIRS), and may die if not treated with sufficient exogenous glucocorticoids. Controversy surrounds what constitutes a ‘normal’ adrenal response in critical illness. This study uses conventional tests for adrenal insufficiency to investigate cortisol status in patients undergoing elective coronary artery bypass surgery, a condition frequently associated with SIRS.DesignA prospective, observational study.MethodsThirty patients with impaired left ventricular function (ejection fraction >23% <50%) underwent basal ACTH measurement, and a short cosyntropin test (250 μg, i.v.) 1 week preoperatively, and at +4 h following induction of general anaesthesia. Preoperatively, a 30 min cortisol level post cosyntropin >550 nmol/l was taken as a normal response.ResultsPrior to surgery, all patients had a normal response to cosyntropin. Postoperatively, eight patients (26.7%) did not achieve stimulated cortisol levels >550 nmol/l and the mean peak cortisol postoperatively was lower (1048 vs 730 nmol/l; P<0.001). There was a significant rise in ACTH after surgery (21 vs 184 ng/l; P=0.007) and reduction in Δ-cortisol post cosyntropin (579 vs 229 nmol/l; P<0.001). There was no change in basal cortisol pre- and post-operatively (447 vs 501; P=0.4). All patients underwent routine, uneventful postoperative recovery.ConclusionUp to one quarter of patients with a normal cortisol status preoperatively demonstrated a raised ACTH and deficient cortisol response postoperatively. Despite these responses, all patients had uneventful outcomes. These data reinforce the need for caution when interpreting results of endocrine testing following major surgery or in the intensive care environment, and that prognostic value of these results may be of limited use.

U2 - 10.1530/eje-10-0996

DO - 10.1530/eje-10-0996

M3 - Article

SN - 0804-4643

VL - 164

SP - 413

EP - 419

JO - European Journal of Endocrinology

JF - European Journal of Endocrinology

IS - 3

ER -

Assessing adrenal status in patients before and immediately after coronary artery bypass graft surgery

Abstract

UN SDGs

Access to Document

Fingerprint

Cite this