Endocrine Effects of Arginine-Vasopressin After Pediatric Cardiac Surgery
Ilias Iliopoulos1, Saul Flores2, Matthew Coghill3
1Cardiac Intensive Care, Heart Center, INOVA Children's Hospital, 3300 Gallows Road, Falls Church, VA, USA. ilias.iliopoulos@inova.org.
Insights
Arginine-vasopressin (AVP) therapy did not significantly change adrenocorticotropic hormone (ACTH) or cortisol levels in children after congenital heart surgery. Hemodynamic benefits of AVP are likely not due to the hypothalamic-pituitary-adrenal axis.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Arginine-vasopressin (AVP) is known to stimulate adrenocorticotropic hormone (ACTH) secretion and may play a role in the surgical stress response.
- The specific endocrine effects of AVP in pediatric patients undergoing congenital heart surgery are not well understood.
- Understanding these effects is crucial for optimizing perioperative management and patient outcomes.
Purpose of the Study:
- To prospectively evaluate the endocrine effects of arginine-vasopressin (AVP) therapy on adrenocorticotropic hormone (ACTH) and cortisol levels in children after congenital heart surgery.
- To determine if AVP administration influences the hypothalamic-pituitary-adrenal (HPA) axis in this pediatric population.
- To explore associations between AVP levels, hormone concentrations, and hemodynamic parameters.
Main Methods:
- A prospective cohort study involving 49 children (median age 8 months) after corrective cardiac surgery with cardiopulmonary bypass.
- Patients were divided into two groups: those receiving AVP postoperatively (n=23) and those not treated (n=26).
- Serial measurements of cortisol, ACTH, sodium, and glucose were analyzed, alongside baseline hormone levels (AVP, ACTH, cortisol, cortisol-binding globulin) and time-series linear regression models were employed.
Main Results:
- No significant differences in ACTH or cortisol levels were observed over time between AVP-treated and untreated groups.
- A trend towards higher cortisol levels was noted in AVP-treated patients, although this was not statistically significant.
- Regression analyses revealed significant associations between ACTH and cortisol, cortisol and systolic blood pressure, and baseline AVP levels with systolic blood pressure and renal oxygen extraction ratio.
Conclusions:
- Arginine-vasopressin (AVP) therapy did not significantly alter ACTH or cortisol levels in children following congenital heart surgery.
- Cortisol and baseline AVP levels were independently associated with hemodynamic markers in this cohort.
- The hemodynamic benefits of AVP in pediatric cardiac surgery are unlikely to be mediated through activation of the hypothalamic-pituitary-adrenal axis, warranting further investigation in larger studies.
Abstract:
Arginine-vasopressin (AVP) stimulates adrenocorticotropic hormone (ACTH) secretion and may contribute to the stress response after surgery. Its endocrine effects in children undergoing congenital heart surgery remain unclear. We prospectively evaluated 49 children (median age 8 months, IQR 5-59 months; median weight 11.0 kg, IQR 7.2-26.3 kg) after corrective cardiac surgery with cardiopulmonary bypass. Patients receiving AVP within 48 h postoperatively (n = 23) were compared with those not treated (n = 26). Baseline hormone levels (AVP, ACTH, cortisol, cortisol-binding globulin) were measured. Serial cortisol, ACTH, sodium, and glucose levels were analyzed. Time-series linear regression models examined associations between AVP therapy and adjusting for covariates such as cortisol, ACTH, CBG, and AVP levels. Baseline did not differ between groups. AVP therapy was not associated with significant differences in ACTH or cortisol over time. A non-significant trend toward higher cortisol was observed in AVP-treated patients. Regression analyses demonstrated significant associations between ACTH and cortisol (coefficient = 0.0325, p < 0.01), cortisol and systolic blood pressure (coefficient = 0.005, p < 0.01), and baseline AVP level with systolic blood pressure (coefficient = 0.003, p < 0.01) and renal oxygen extraction ratio (coefficient = 0.124, p = 0.01) and hormone levels. In this prospective cohort of children after congenital heart surgery, AVP therapy did not significantly alter ACTH or cortisol levels. Cortisol and baseline AVP levels were independently associated with hemodynamic markers. These findings suggest that the hemodynamic benefit of AVP is unlikely to be mediated through hypothalamic-pituitary-adrenal axis activation. Larger studies are needed to confirm these results.
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