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July 1987

Hormonal Responses to Graded Surgical Stress

Author Affiliations

From the Departments of Critical Care Medicine (Drs Chernow, Cook, and Beardsley) and Surgery (Drs Alexander, Thompson, Fink, and Fletcher), Naval Hospital, and the Departments of Medicine (Drs Chernow and Smallridge), Surgery (Drs Fink, Thompson, and Fletcher), Pharmacology (Dr Lake), and Psychiatry (Dr Lake), the Uniformed Services University of the Health Sciences, School of Medicine, Bethesda, Md; and the Department of Clinical Physiology, Walter Reed Army Institute of Research, Washington, DC (Dr Smallridge). Dr Chernow is now with the Massachusetts General Hospital and Harvard Medical School, Boston; Dr Fink is now with the University of Massachusetts Medical Center, Worcester; and Dr Fletcher is now with St Thomas Hospital, Nashville, Tenn.

Arch Intern Med. 1987;147(7):1273-1278. doi:10.1001/archinte.1987.00370070087013

• We tested the hypothesis that selected hormonal responses to surgery reflect the degree of surgical stress. Plasma norepinephrine, epinephrine, thromboxane B2, cortisol, serum angiotensin converting enzyme, thyroxine, triiodothyronine, free thyroxine, and free triiodothyronine levels were measured preoperatively, and then one hour, 24 hours, and five days postoperatively in three groups of patients. The groups were as follows: group 1, "minimal" stress, eg, inguinal hernia repair (n =10); group 2, "moderate" stress, eg, cholecystectomy (n =12); and group 3, "severe" stress, eg, subtotal colectomy (n = 9). Patients in group 1 showed no significant surgery-induced changes in hormonal values. The stress-Induced changes in patients in groups 2 and 3 were seen at one and occasionally 24 hours; however, by five days postoperatively, circulating hormone values had returned to preoperative levels. Increases in plasma cortisol, norepinephrine, and epinephrine, and decreases in serum angiotensin converting enzyme levels characterized the surgery-induced hormonal changes. Conclusions are as follows: (1) hormonal responses do reflect the degree of surgical stress; (2) the hormonal changes are transient, lasting no longer than 24 hours in patients after uncomplicated surgery; (3) hormonal responses to minimal surgical stress are negligible.

(Arch Intern Med 1987;147:1273-1278)

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