Pro-opiomelanocortin and ACTH-cortisol dissociation during pediatric cardiac surgery.

Autor:	Téblick A; A Téblick, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium., Vanhorebeek I; I Vanhorebeek, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium., Derese I; I Derese, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium., Jacobs A; A Jacobs, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium., Haghedooren R; R Haghedooren, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium., Maebe S; S Maebe, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium., Zeilmaker-Roest GA; G Zeilmaker-Roest, Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands, Sophia Children's Hospital, Rotterdam, Netherlands., Wildschut ED; E Wildschut, Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands, Sophia Children's Hospital, Rotterdam, Netherlands., Langouche L; L Langouche, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium., Van den Berghe G; G Van den Berghe, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium.
Jazyk:	angličtina
Zdroj:	Endocrine connections [Endocr Connect] 2024 Apr 01. Date of Electronic Publication: 2024 Apr 01.
DOI:	10.1530/EC-24-0078
Abstrakt:	In critically ill adults, high plasma cortisol in face of low ACTH coincides with high pro-opiomelanocortin (POMC) levels. Glucocorticoids further lower ACTH without affecting POMC. We hypothesized that in pediatric cardiac surgery-induced critical illness, plasma POMC is elevated, plasma ACTH transiently rises intraoperatively but becomes suppressed post-operatively, and glucocorticoid administration amplifies this phenotype. From 53 patients (0-36 months), plasma was obtained pre-operatively, intraoperatively and on post-operative day 1 and 2. Plasma was also collected from 24 healthy children. In patients, POMC was supra-normal pre-operatively (p<0.0001) but no longer thereafter (p<0.05). ACTH was never high in patients. While in glucocorticoid-naive patients ACTH became suppressed by post-operative day 1 (p<0.0001), glucocorticoid-treated patients had suppressed ACTH already intraoperatively (p≤0.0001). Pre-operatively high POMC, not accompanied by increased plasma ACTH, suggests a centrally-activated HPA-axis with reduced pituitary processing of POMC into ACTH. Increasing systemic glucocorticoid availability with glucocorticoid treatment accelerated the suppression of plasma ACTH.
Databáze:	MEDLINE
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