CORTICOSTEROID RESPONSE TO SURGERY: EFFECT OF TESTOSTERONE

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Abstract
THE trauma of a surgical operation is quickly followed by a release of corticotropin from the anterior pituitary, which in its turn stimulates the adrenal cortex to synthesize and secrete 17-hydroxycorticosteroids (17-OHCS). The rise in the level of free and conjugated plasma 17-OHCS lasts for a few days (1) and reflects a balance between the rate of secretion of free 17-OHCS, and their conjugation and elimination by metabolism or urinary excretion. It has been amply demonstrated that although there is some loose relationship between the amount of surgical trauma, the rise in plasma 17-OHCS levels and the total urinary corticosteroid excretion, many other factors are probably involved, such as the age of the patient or the type of disease (2). Even when these known influences are taken into account it is difficult to explain the wide differences in plasma levels and urinary 17-OHCS excretion among a fairly homologous group of patients following a standard operation such as partial gastrectomy (2). It is therefore of interest to find other causes for these variations. Gemzell and Notter (3) observed that when androgens were administered for some days before operation the expected rise in the plasma level of free 17-OHCS failed to occur. In patients not receiving androgens, the plasma level increased from the preoperative average value of 5.6 μg. per 100 ml. to 31.4 μg. per 100 ml. at one hour, and 29.5 μg. per 100 ml. at twenty-four hours after operation; whereas in 5 patients receiving testosterone propionate for four to six days the plasma levels were no higher than 7.0 μg. per 100 ml.