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Téblick A, Vanhorebeek I, Derese I, Jacobs A, Haghedooren R, Maebe S, Zeilmaker-Roest GA, Wildschut ED, Langouche L, Van den Berghe G. Pro-opiomelanocortin and ACTH-cortisol dissociation during pediatric cardiac surgery. Endocr Connect 2024:EC-24-0078. [PMID: 38657653 DOI: 10.1530/ec-24-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 04/23/2024] [Indexed: 04/26/2024]
Abstract
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.
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Affiliation(s)
- Arno Téblick
- 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
| | - Ilse Vanhorebeek
- 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
| | - Inge Derese
- 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
| | - An Jacobs
- 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
| | - Renata Haghedooren
- 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
| | - Sofie Maebe
- 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
| | - Gerdian A Zeilmaker-Roest
- 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
| | - Enno D Wildschut
- 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
| | - Lies Langouche
- L Langouche, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Greet Van den Berghe
- 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
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