Parker L, Eugene J, Farber D, Lifrak E, Lai M, Juler G
Horm Metab Res. 1985 Apr;17(4):209-12. doi: 10.1055/s-2007-1013493.
Patients recovering from acute surgical stress often excrete increased 17-OH corticosteroids with no change in 17-ketosteroids. The explanation for these findings is unclear. In order to investigate possible divergence between cortisol and adrenal androgen metabolism in acute stress, repeated morning cortisol and dehydroepiandrosterone (DHA) measurements were made in patients undergoing ACTH stimulation 48 to 96 hours preoperatively, followed by determinations before and during major surgery, also performed in the morning. Cortisol and DHA are largely metabolized by the liver, so liver blood flow under a constant general anesthetic regimen known not to affect cortisol metabolism was monitored by pre- and intraoperative indocyanine green dye clearance. Results indicated no difference between the cortisol and DHA stimulation resulting from two hours of ACTH stimulation or major surgery, and a small (14.4%) decline in hepatic blood flow during general anesthesia. However, while DHA concentrations remained constant immediately preceding surgery, cortisol concentrations increased by 61% (P less than 0.05). Previous studies have also demonstrated increased concentrations of cortisol before surgical procedures, presumably due to psychological stress. However, this is the first demonstration of a dissociation between concentrations of cortisol and an adrenal androgen due to psychological stress.
急性手术应激恢复过程中的患者通常排泄出更多的17-羟基皮质类固醇，而17-酮类固醇却没有变化。这些发现的原因尚不清楚。为了研究急性应激状态下皮质醇和肾上腺雄激素代谢之间可能存在的差异，对术前48至96小时接受促肾上腺皮质激素（ACTH）刺激的患者进行了多次晨间皮质醇和脱氢表雄酮（DHA）测量，随后在早晨进行大手术前及手术期间也进行了测定。皮质醇和DHA主要在肝脏中代谢，因此在已知不影响皮质醇代谢的恒定全身麻醉方案下，通过术前及术中吲哚菁绿染料清除率监测肝血流量。结果表明，两小时的ACTH刺激或大手术所导致的皮质醇和DHA刺激之间没有差异，并且全身麻醉期间肝血流量略有下降（14.4%）。然而，尽管术前即刻DHA浓度保持恒定，但皮质醇浓度却增加了61%（P小于0.05）。先前的研究也表明手术前皮质醇浓度升高，推测是由于心理应激所致。然而，这是首次证明心理应激导致皮质醇和肾上腺雄激素浓度之间出现分离。
