Relative adrenal insufficiency after major abdominal surgery

Introduction

Relative adrenal insufficiency has been described in diverse critical ill states; however, this issue has not been investigated following major abdominal surgery. The aim of the present study was to gain insight on this topic.

Methods

Thirty-two consecutive patients (16 men), with a mean age of 69 ± 10 years, were enrolled. All patients underwent elective, major abdominal surgery. Underlying diagnoses included carcinoma of the intestine (n = 12), carcinoma of the stomach (n = 8), carcinoma of the pancreas (n = 5), carcinoma of the esophagus (n = 1) and abdominal aorta aneurysm (n = 6). Blood sampling was performed preoperatively to measure morning baseline cortico-tropin (ACTH) and cortisol levels. Furthermore, a low-dose (1 μg) corticotropin stimulation test was carried out to determine stimulated cortisol. The same measurements were performed on the first postoperative day. Relative adrenal insufficiency was defined as stimulated cortisol less than 18 μg/dl.

Results

Preoperative measurements: median ACTH and mean baseline cortisol were 13 pg/ml and 15 ± 5 μg/dl, respectively, while stimulated cortisol was 25 ± 7 μg/dl. One patient (3%) had relative adrenal insufficiency (stimulated cortisol was 16 μg/dl). Postoperative results: median ACTH and mean baseline cortisol were 12 pg/ml and 17 μg/dl, respectively, whereas stimulated cortisol was 23 ± 12 μg/dl. Nine patients (28%) had relative adrenal insufficiency (stimulated cortisol ranged from 12 to 17 μg/dl).

Conclusion

Relative adrenal insufficiency occurs in a substantial proportion of patients following major abdominal surgery. Pre-operative adrenal function does not seem to determine postoperative adrenal responses.