The effects of cortisol supplementation on the metabolic and hormonal response to surgery

The role of cortisol in determining the metabolic and hormonal changes associated with a standardized surgical operation was investigated. Twelve patients undergoing pelvic surgery were studied. Six received steroid supplementation with an infusion of hydrocortisone sodium succinate at a rate of 8 mg/h for 24 h, together with 1.5 g hydrocortisone acetate intraperitoneally at the completion of surgery, while the remainder acted as a control group. Steroid supplementation resulted in plasma cortisol values in the range 1913-2265 nmol/l from 4 to 24 h after the start of surgery. However, this marked hypercortisolaemia had no significant effects on circulating metabolites other than glucose, and did not alter plasma ACTH, GH and insulin values. The usual glycaemic response to surgery was significantly augmented by 1.0-1.5 mmol/l in the cortisol group. We conclude that changes in substrate mobilization observed after cortisol administration in normal volunteers may not accurately predict the effects found after surgery, when catabolic hormones and other modulators such as interleukin-1 may influence metabolism.