Endocrine responses to major abdominal surgery

The purpose of the current study was to assess the pattern of endocrine responses in patients undergoing elective major abdominal surgery. To this end, 16 patients (nine women) with a mean age of 71 ± 9 years (range, 48–87 years) were studied. Underlying diagnoses included carcinoma of the pancreas (n = 5), stomach (n = 4), colon (n = 4) and rectum (n = 3). Blood was taken before surgery (day -1), immediately after the operation (day 0), and on the two subsequent days (day 1 and day 2). At each sample time cortisol (F), corticotropin (ACTH), triiodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH), and insulin-like growth factor 1 (IGF-1) were determined. Serial measurements were analyzed by one-way analysis of variance followed by Dunn's test for multiple comparisons, and the results are presented in Table 1 (median values or mean ± standard deviation).

Table 1

In conclusion, major surgical stress results in a profound, albeit transient, activation of the hypothalamic–pituitary–adrenal axis. Furthermore, surgery leads to a suppression of thyroid and somatotroph function, and this effect persists for more than 2 days. The relationship between hormonal responses and patients' outcome remains to be determined.