The Effects of Surgery on the Blood Levels and Metabolism and 17-Hydroxycorticosteroids in Man12

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Abstract
The plasma levels of 17-hydroxycorticosteroids were determined in a group of surgical patients. They were found to be elevated following the induction of anesthesia and during and after surgery. Following surgery the increases were roughly proportional to the duration and severity of the operative procedure. This elevation usually persisted at least 6 hours following surgery. In an attempt to measure adrenal cortical capacity, the changes in 17-hydroxycorticosteroid levels following intravenous administration of ACTH were determined in a group of patients preoperatively, and again shortly after surgery. Even when the post-operative levels of 17-hydroxycorticosteroids rose spontaneously to levels as high as those induced by ACTH in normals, the administration of ACTH was associated with an additional increment. Some patients undergoing surgery did not metabolize intravenously administered hydrocortisone as rapidly after surgery as they did on control days. The data seem most consistent with the hypothesis that the adrenal is submaximally stimulated by surgical trauma but that impaired disappearance of circulating steroid also contributes to the rises observed.