UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Re-defining the stress cortisol response to surgery

Khoo, B; Boshier, PR; Freethy, A; Tharakan, G; Saeed, S; Hill, N; Williams, EL; ... Tan, T; + view all (2017) Re-defining the stress cortisol response to surgery. Clinical Endocrinology , 87 (5) pp. 451-458. 10.1111/cen.13439. Green open access

[thumbnail of Article]
Preview
Text (Article)
Khoo_Cortisol in Surgery Paper 170724 Accepted Version.pdf - Accepted Version

Download (306kB) | Preview
[thumbnail of Figure 1]
Preview
Text (Figure 1)
Khoo_Figure1.pdf - Accepted Version

Download (41kB) | Preview
[thumbnail of Figure 2]
Preview
Text (Figure 2)
Khoo_figure2.pdf - Accepted Version

Download (38kB) | Preview
[thumbnail of Figure 3]
Preview
Text (Figure 3)
Khoo_figure3.pdf - Accepted Version

Download (31kB) | Preview
[thumbnail of Figure 4]
Preview
Text (Figure 4)
Khoo_figure4.pdf - Accepted Version

Download (40kB) | Preview

Abstract

BACKGROUND: Cortisol levels rise with the physiological stress of surgery. Previous studies have used older, less-specific assays, have not differentiated by severity, or only studied procedures of a defined type. The aim of this study was to examine this phenomenon in surgeries of varying severity using a widely used cortisol immunoassay. METHODS: Euadrenal patients undergoing elective surgery were enrolled prospectively. Serum samples were taken at 8 am on surgical day, induction and 1 hr, 2 hr, 4 hr and 8 hr after. Subsequent samples were taken daily at 8 am until post-operative day 5 or hospital discharge. Total cortisol was measured using an Abbott Architect immunoassay, and cortisol binding globulin (CBG) using a radioimmunoassay. Surgical severity was classified by POSSUM operative severity score. RESULTS: 93 patients underwent surgery: Major/Major+ (n=37), Moderate (n=33), and Minor (n=23). Peak cortisol positively correlated to severity: Major/Major+ median 680 [range 375-1452], Moderate 581 [270-1009], and Minor 574 [272-1066] nmol/L (Kruskal-Wallis test, P=0.0031). CBG fell by 23%; the magnitude of the drop positively correlated to severity. CONCLUSIONS: The range in baseline and peak cortisol response to surgery is wide, and peak cortisol levels lower than previously appreciated. Improvements in surgery, anaesthetic techniques, and cortisol assays might explain our observed lower peak cortisols. The criteria for the dynamic testing of cortisol response may need to be reduced to take account of these factors. Our data also support a lower-dose, stratified approach to dosing of steroid replacement in hypoadrenal patients, to minimise the deleterious effects of over-replacement.

Type: Article
Title: Re-defining the stress cortisol response to surgery
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/cen.13439
Publisher version: http://doi.org/10.1111/cen.13439
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Cortisol, Cortisol Binding Globulin, Stress Response, Surgery
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine > Renal Medicine
URI: https://discovery.ucl.ac.uk/id/eprint/1569762
Downloads since deposit
323Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item