Evidence Based Practice and Quality Assurance
Background and Goal of Study: Few epidemiological data exist on the adrenal function in patients undergoing elective abdominal surgery. Therefore patients with pathological adrenal response were identified by a preoperative ACTH stimulation test and followed till discharge.
Materials and Methods: After approval of the ethics committee and informed consent of the participants, adult patients scheduled for major abdominal surgery were enrolled in this study. Patients with a history of glucocorticoid therapy, endocrine diseases, acute pulmonary or any other medical complaints were excluded. For the low-dose ACTH test, an intravenous bolus injection of 1 mcg (1-24)-corticotropin was given. Baseline and stimulated plasma cortisol were measured on the day before surgery (p1), immediately after surgery (p2), in the morning of the first postoperative day (p3) and the day of discharge (p4). A normal response to intravenous ACTH was defined as a stimulated plasma cortisol concentration >550 nmol/l (20 mcg/dl).
Results and Discussions: 99 patients were included in this cohort study and all patients were followed according to the protocol. Pathological subgroup: At p1, 41 of 99 patients had a formal pathological ACTH test. 26 (63%) of this group (n = 41) had also a deficient response to ACTH immediately after surgery. On the first postoperative and the discharge day, in 20 patients (48.7%) the test remained pathological. The other patients of this subgroup had a normal response to ACTH under the surgical stress (p2-p4). Normal subgroup: At p1 58 of 99 patients had a normal ACTH test. 36(61 %) of them (n = 58) had also a normal response to ACTH immediately after surgery. In 33 patients of this group the low dose ACTH test on the first postoperative day was normal. At discharge day, 40 patients were normal. The summarised results of the ACTH tests for both groups were as following: 58.6% of 99 patients at p1, 51.5% (n = 51) at p2, 54.5% (n = 54) at p3 and 60.6% (60) had a normal response to all the low-dose ACTH tests performed pre- and postoperatively.
Conclusion(s): In a high proportion of these cohort partial adrenal insufficiency can be diagnosed. In the majority of these patients the adrenal response to ACTH remains deficient in the postoperative time.