Zur Notwendigkeit der perioperativen Kortisolsubstitution : Spontane und stimulierte ACTH- und Kortisolsekretion nach unilateraler Adrenalektomie beim Nierenzellkarzinom

摘要: Impaired adrenal function during perioperative stress carries the risk of acute cortisol (Cs) deficiency (Addisonian crisis),which may be critical without Cs supplementation. Thus, with evidence dysfunction glands substitution is indicated. However, it unclear whether unilateral adrenalectomy attenuate adrenocorticoid response. Glucocorticosteroids are potent agents several well-known side effects.The purpose present study was to evaluate if routine supplementation isjustified and necessary in patients undergoing nephrectomy for renal-cell cancer. Methods: Ten consecutive cancer (5 male, 5 female;age 58±10 years; ASA class I-II) who underwent radical were included this study. None them had received steroids at least years priorto current surgery. Anaesthesia induced propofol, fentanyl, vecuronium maintained isoflurane (P et Iso: 0.8±0.3 vol.%) nitrous oxide (66%) oxygen.The did not receive any treatment perioperatively. Monitoring heart rate (beats/min), mean arterial pressure (mm Hg), central venous O 2 saturation (%),and body temperature (°C, rectal). Plasma analyses (Cs radioimmunoassay IBL; normal 120-250 ng/ml),adrenocorticotropic hormone (ACTH) (ACTH-II IRMA; (10-50 pg/ml), glucose, electrolytes determined as follows: preoperatively (8 a.m.);1-6 h (60-min intervals) after surgery; pre-corticotropin-releasing (CRH) (Corticobiss®:2 μg/kg i.v.) administration (1st postop. day 8 a.m. 30,60,90, 120 min.The completed plasma on postoperative days 3(8 a.m.). Results: showed clinical signs parameters insufficiency due adrenalectomy. Serum levels (median:25%/75% percentiles) (maximum [max.]: 253 [217/288] ng/ml) ACTH (max.: 347 ([68/405] pg/ml) elevated above range postoperatively). After intravenous stimulation CRH day), 273 [248/310] (max.:107 ([75/275] also increased normal. During 3 a.m.) remained high-normal range. Conclusions: Data from indicate that associated adequate spontaneous secretion by remaining gland. Moreover, demonstrated reactivity pituitary-adrenal axis. or serum parameters.Therefore,we do recommend tumor nephrectomy, nevertheless, remains primary hypothala mic-pituitary-adrenal (Addison's disease) hyperfunction (Cushing's disease).