Alessandro Prete1,2, Qi Yan3, Khaled Al-Tarrah4, Halis K Akturk5, Larry J Prokop6, Fares Alahdab7, Mark A Foster4,8, Janet M Lord4, Niki Karavitaki1,2, John A Wass9, Mohammad H Murad7, Wiebke Arlt1,2, Irina Bancos10. 1. Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK. 2. Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, Birmingham, UK. 3. Department of Surgery, Mayo Clinic, Rochester, Minnesota. 4. Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK. 5. Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado. 6. Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota. 7. Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota. 8. NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham & Royal Centre for Defence Medicine, Birmingham, UK. 9. Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK. 10. Division of Endocrinology, Metabolism and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Abstract
OBJECTIVE: Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined. DESIGN: We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters. METHODS: We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in meta-analysis and plotted over time. RESULTS: We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, women and patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response. CONCLUSIONS: The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response.
OBJECTIVE: Surgery is a stressor that can be categorized by duration and severity and induces a systemic stress response that includes increased adrenal cortisol production. However, the precise impact of surgical stress on the cortisol response remains to be defined. DESIGN: We performed a systematic review and meta-analysis to assess the cortisol stress response induced by surgery and to stratify this response according to different parameters. METHODS: We conducted a comprehensive search in several databases from 1990 to 2016. Pairs of reviewers independently selected studies, extracted data and evaluated the risk of bias. Cortisol concentrations were standardized, pooled in meta-analysis and plotted over time. RESULTS: We included 71 studies reporting peri-operative serum cortisol measurements in 2953 patients. The cortisol response differed substantially between moderately/highly invasive and minimally invasive surgical procedures. Minimally invasive procedures did not show a peri-operative cortisol peak, whereas more invasive surgeries caused a cortisol surge that was more pronounced in older subjects, women and patients undergoing open surgery and general anaesthesia. The duration of the procedure and the use of etomidate for induction of anaesthesia did not affect the cortisol response. CONCLUSIONS: The peri-operative cortisol stress response is dynamic and influenced by patient-specific, surgical and anaesthetic features. However, the available evidence is derived from highly heterogeneous studies, with only two of 71 studies measuring cortisol by mass spectrometry, which currently prevents a precise and reproducible definition of this response.
Authors: Lina Schiffer; Lise Barnard; Elizabeth S Baranowski; Lorna C Gilligan; Angela E Taylor; Wiebke Arlt; Cedric H L Shackleton; Karl-Heinz Storbeck Journal: J Steroid Biochem Mol Biol Date: 2019-07-27 Impact factor: 4.292
Authors: Alessandro Prete; Angela E Taylor; Irina Bancos; David J Smith; Mark A Foster; Sibylle Kohler; Violet Fazal-Sanderson; John Komninos; Donna M O'Neil; Dimitra A Vassiliadi; Christopher J Mowatt; Radu Mihai; Joanne L Fallowfield; Djillali Annane; Janet M Lord; Brian G Keevil; John A H Wass; Niki Karavitaki; Wiebke Arlt Journal: J Clin Endocrinol Metab Date: 2020-07-01 Impact factor: 5.958