Impact of Adrenal Function on Hemostasis/Endothelial Function in Patients Undergoing Surgery

Area of Science:

• Endocrinology
• Surgical Physiology
• Hemostasis and Thrombosis

Background:

• Glucocorticoids are vital for surgical adaptation, influencing hemostatic and endothelial functions.
• Limited data exist on adrenal function's impact on perioperative hemostasis and endothelial function.

Purpose of the Study:

• To investigate the association between adrenal response to adrenocorticotropic hormone (ACTH) and markers of endothelial and hemostatic function in surgical patients.
• To classify patients based on hypothalamic-pituitary-adrenal (HPA)-axis function (normal vs. deficient) using ACTH stimulation tests.

Main Methods:

• Prospective observational study of 60 patients undergoing abdominal surgery.
• Adrenal function assessed via low-dose ACTH stimulation test preoperatively, intraoperatively, and postoperatively.
• Endothelial (sVCAM-1, thrombomodulin) and hemostatic (fibrinogen, vWF, FVIII) markers measured during surgery.

Main Results:

• 21 patients (35%) had deficient HPA-axis function (dHPA); 39 (65%) had normal HPA-axis function (nHPA).
• dHPA patients exhibited significantly lower peak cortisol levels and reduced postoperative hemoglobin.
• Factor VIII (FVIII) was significantly lower in dHPA patients; other markers showed no significant difference. A turning point for coagulation/endothelial markers was observed between 500-600 nmol/L cortisol.

Conclusions:

• Deficient HPA-axis function in surgical patients is linked to impaired hemostasis.
• Impaired hemostasis in dHPA patients may contribute to excessive perioperative blood loss.
• Assessment of HPA-axis function may be crucial for managing surgical patients at risk for bleeding.