Adrenal insufficiency after cardiovascular surgery with cardiopulmonary bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Yu ¹ ,  HU Jia ² , YANG Peng ² , LU Chen ² , HUANG Yao ² , ZHANG Hongwei ²

1. West China School of Medicine, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

HU Jia, Email: humanjia@msn.com

Keywords：

Cardiopulmonary bypass surgery; adrenal insufficiency; adrenal crisis

DOI：

10.7507/1007-4848.201906075

Video：

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Relative/absolute adrenal insufficiency is not uncommmon in the patients undergoing cardiovascular surgery with cardiopulmonary bypass. However, this complication was rarely reported due to its unspecific clinical presentations and the unawareness of ICU physicians and cardiac surgeons. However, this puts them on a higher risk of hemodynamic instability and cardiovascular adverse events during hospitalization. Systematic reviews concentrated on it are rarely reported currently. We aim to review the etiology, risk factors, potential pathogenesis and related research progress for this complication.

Citation： ZHANG Yu, HU Jia, YANG Peng, LU Chen, HUANG Yao, ZHANG Hongwei. Adrenal insufficiency after cardiovascular surgery with cardiopulmonary bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(1): 85-89. doi: 10.7507/1007-4848.201906075 Copy

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2.	蔡子仁, 冯伦超, 周新明. 体外循环前应用低分子肝素对行主动脉瓣置换术患者肺表面活性因子和氧化应激的影响. 中华实用诊断与治疗杂志, 2019, 33(5): 494-497.
3.	Annane D, Pastores SM, Rochwerg B, et al. Correction to: Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med, 2018, 44(3): 401-402.
4.	Peeters B, Meersseman P, Vander Perre S, et al. Adrenocortical function during prolonged critical illness and beyond: a prospective observational study. Intensive Care Med, 2018, 44(10): 1720-1729.
5.	马婧, 张伟. 危重症相关性肾上腺皮质功能不全的研究进展. 中华重症医学电子杂志(网络版), 2017, 3(3): 220-225.
6.	Mazine A, Bouhout I, Saydy N, et al. Relative adrenal insufficiency is associated with prolonged postoperative hemodynamic instability. Ann Thorac Surg, 2018, 106(3): 702-707.
7.	Chabre O, Goichot B, Zenaty D, et al. Group 1. Epidemiology of primary and secondary adrenal insufficiency: Prevalence and incidence, acute adrenal insufficiency, long-term morbidity and mortality. Ann Endocrinol (Paris), 2017, 78(6): 490-494.
8.	Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2016, 101(2): 364-389.
9.	Ok YJ, Lim JY, Jung SH. Critical illness-related corticosteroid insufficiency in patients with low cardiac output syndrome after cardiac surgery. Korean J Thorac Cardiovasc Surg, 2018, 51(2): 109-113.
10.	Iribarren JL, Jiménez JJ, Hernández D, et al. Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study. J Cardiothorac Surg, 2010, 5: 26.
11.	Menon K, Ward RE, Lawson ML, et al. A prospective multicenter study of adrenal function in critically ill children. Am J Respir Crit Care Med, 2010, 182(2): 246-251.
12.	Hilbert T, Duerr GD, Hamiko M, et al. Endothelial permeability following coronary artery bypass grafting: an observational study on the possible role of angiopoietin imbalance. Crit Care, 2016, 20: 51.
13.	Boonen E, Bornstein SR, Van den Berghe G. New insights into the controversy of adrenal function during critical illness. Lancet Diabetes Endocrinol, 2015, 3(10): 805-815.
14.	沈嘉渝, 张尔永, 胡佳. 体外循环急性肺损伤与肺保护策略的研究进展. 中国胸心血管外科临床杂志, 2019, 26(2): 186-191.
15.	Poli EC, Alberio L, Bauer-Doerries A, et al. Cytokine clearance with CytoSorb during cardiac surgery: a pilot randomized controlled trial. Crit Care, 2019, 23(1): 108.
16.	Lucas SS, Nasr VG, Ng AJ, et al. Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in cardiac critical care: sedation, analgesia and muscle relaxant. Pediatr Crit Care Med, 2016, 17(3 Suppl 1): S3-S15.
17.	Ramanathan ML, Roxburgh CS, Guthrie GJ, et al. Is perioperative systemic inflammation the result of insufficient cortisol production in patients with colorectal cancer? Ann Surg Oncol, 2013, 20(7): 2172-2179.
18.	Peeters B, Meersseman P, Vander Perre S, et al. ACTH and cortisol responses to CRH in acute, subacute, and prolonged critical illness: a randomized, double-blind, placebo-controlled, crossover cohort study. Intensive Care Med, 2018, 44(12): 2048-2058.
19.	Soto-Rivera CL, Schwartz SM, Sawyer JE, et al. Endocrinologic diseases in pediatric cardiac intensive care. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S296-S301.
20.	Boonen E, Van den Berghe G. Mechanisms in endocrinology: New concepts to further unravel adrenal insufficiency during critical illness. Eur J Endocrinol, 2016, 175(1): R1-R9.
21.	Petrescu AD, Kain J, Liere V, et al. Hypothalamus-pituitary-adrenal dysfunction in cholestatic liver disease. Front Endocrinol (Lausanne), 2018, 9: 660.
22.	Anderson GW, Kenyon CJ, Al-Dujaili EAS. Post-prandial changes in salivary glucocorticoids: effects of dietary cholesterol and associations with bile acid excretion. Nutrients, 2019, 11(2): E360.
23.	McMillin M, DeMorrow S. Effects of bile acids on neurological function and disease. FASEB J, 2016, 30(11): 3658-3668.
24.	Liu X, Xue R, Yang C, et al. Cholestasis-induced bile acid elevates estrogen level via farnesoid X receptor-mediated suppression of the estrogen sulfotransferase SULT1E1. J Biol Chem, 2018, 293(33): 12759-12769.
25.	Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet, 2014, 383(9935): 2152-2167.
26.	Téblick A, Peeters B, Langouche L, et al. Adrenal function and dysfunction in critically ill patients. Nat Rev Endocrinol, 2019, 15(7): 417-427.
27.	Burfeind KG, Yadav V, Marks DL. Hypothalamic dysfunction and multiple sclerosis: implications for fatigue and weight dysregulation. Curr Neurol Neurosci Rep, 2016, 16(11): 98.
28.	Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis. Cochrane Database Syst Rev, 2015, (12): CD002243.
29.	Volbeda M, Wetterslev J, Gluud C, et al. Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis. Intensive Care Med, 2015, 41(7): 1220-1234.
30.	Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med, 2018, 378(9): 797-808.
31.	Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med, 2018, 378(9): 809-818.
32.	Ottens TH, Nijsten MW, Hofland J, et al. Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial. Crit Care, 2015, 19: 41.
33.	Gorenek B, Pelliccia A, Benjamin EJ, et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace, 2017, 19(2): 190-225.
34.	Jones DP, Patel J. Therapeutic approaches targeting inflammation in cardiovascular disorders. Biology (Basel), 2018, 7: 49.
35.	Yanase T, Tajima T, Katabami T, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J, 2016, 63(9): 765-784.

1. 秦美玉, 孙俊娜, 郑东友. 体外循环和机血回输对围术期凝血功能的影响. 中国体外循环杂志, 2019, 17(2): 125-128.
2. 蔡子仁, 冯伦超, 周新明. 体外循环前应用低分子肝素对行主动脉瓣置换术患者肺表面活性因子和氧化应激的影响. 中华实用诊断与治疗杂志, 2019, 33(5): 494-497.
3. Annane D, Pastores SM, Rochwerg B, et al. Correction to: Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Med, 2018, 44(3): 401-402.
4. Peeters B, Meersseman P, Vander Perre S, et al. Adrenocortical function during prolonged critical illness and beyond: a prospective observational study. Intensive Care Med, 2018, 44(10): 1720-1729.
5. 马婧, 张伟. 危重症相关性肾上腺皮质功能不全的研究进展. 中华重症医学电子杂志(网络版), 2017, 3(3): 220-225.
6. Mazine A, Bouhout I, Saydy N, et al. Relative adrenal insufficiency is associated with prolonged postoperative hemodynamic instability. Ann Thorac Surg, 2018, 106(3): 702-707.
7. Chabre O, Goichot B, Zenaty D, et al. Group 1. Epidemiology of primary and secondary adrenal insufficiency: Prevalence and incidence, acute adrenal insufficiency, long-term morbidity and mortality. Ann Endocrinol (Paris), 2017, 78(6): 490-494.
8. Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and treatment of primary adrenal insufficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab, 2016, 101(2): 364-389.
9. Ok YJ, Lim JY, Jung SH. Critical illness-related corticosteroid insufficiency in patients with low cardiac output syndrome after cardiac surgery. Korean J Thorac Cardiovasc Surg, 2018, 51(2): 109-113.
10. Iribarren JL, Jiménez JJ, Hernández D, et al. Relative adrenal insufficiency and hemodynamic status in cardiopulmonary bypass surgery patients. A prospective cohort study. J Cardiothorac Surg, 2010, 5: 26.
11. Menon K, Ward RE, Lawson ML, et al. A prospective multicenter study of adrenal function in critically ill children. Am J Respir Crit Care Med, 2010, 182(2): 246-251.
12. Hilbert T, Duerr GD, Hamiko M, et al. Endothelial permeability following coronary artery bypass grafting: an observational study on the possible role of angiopoietin imbalance. Crit Care, 2016, 20: 51.
13. Boonen E, Bornstein SR, Van den Berghe G. New insights into the controversy of adrenal function during critical illness. Lancet Diabetes Endocrinol, 2015, 3(10): 805-815.
14. 沈嘉渝, 张尔永, 胡佳. 体外循环急性肺损伤与肺保护策略的研究进展. 中国胸心血管外科临床杂志, 2019, 26(2): 186-191.
15. Poli EC, Alberio L, Bauer-Doerries A, et al. Cytokine clearance with CytoSorb during cardiac surgery: a pilot randomized controlled trial. Crit Care, 2019, 23(1): 108.
16. Lucas SS, Nasr VG, Ng AJ, et al. Pediatric Cardiac Intensive Care Society 2014 Consensus Statement: Pharmacotherapies in cardiac critical care: sedation, analgesia and muscle relaxant. Pediatr Crit Care Med, 2016, 17(3 Suppl 1): S3-S15.
17. Ramanathan ML, Roxburgh CS, Guthrie GJ, et al. Is perioperative systemic inflammation the result of insufficient cortisol production in patients with colorectal cancer? Ann Surg Oncol, 2013, 20(7): 2172-2179.
18. Peeters B, Meersseman P, Vander Perre S, et al. ACTH and cortisol responses to CRH in acute, subacute, and prolonged critical illness: a randomized, double-blind, placebo-controlled, crossover cohort study. Intensive Care Med, 2018, 44(12): 2048-2058.
19. Soto-Rivera CL, Schwartz SM, Sawyer JE, et al. Endocrinologic diseases in pediatric cardiac intensive care. Pediatr Crit Care Med, 2016, 17(8 Suppl 1): S296-S301.
20. Boonen E, Van den Berghe G. Mechanisms in endocrinology: New concepts to further unravel adrenal insufficiency during critical illness. Eur J Endocrinol, 2016, 175(1): R1-R9.
21. Petrescu AD, Kain J, Liere V, et al. Hypothalamus-pituitary-adrenal dysfunction in cholestatic liver disease. Front Endocrinol (Lausanne), 2018, 9: 660.
22. Anderson GW, Kenyon CJ, Al-Dujaili EAS. Post-prandial changes in salivary glucocorticoids: effects of dietary cholesterol and associations with bile acid excretion. Nutrients, 2019, 11(2): E360.
23. McMillin M, DeMorrow S. Effects of bile acids on neurological function and disease. FASEB J, 2016, 30(11): 3658-3668.
24. Liu X, Xue R, Yang C, et al. Cholestasis-induced bile acid elevates estrogen level via farnesoid X receptor-mediated suppression of the estrogen sulfotransferase SULT1E1. J Biol Chem, 2018, 293(33): 12759-12769.
25. Charmandari E, Nicolaides NC, Chrousos GP. Adrenal insufficiency. Lancet, 2014, 383(9935): 2152-2167.
26. Téblick A, Peeters B, Langouche L, et al. Adrenal function and dysfunction in critically ill patients. Nat Rev Endocrinol, 2019, 15(7): 417-427.
27. Burfeind KG, Yadav V, Marks DL. Hypothalamic dysfunction and multiple sclerosis: implications for fatigue and weight dysregulation. Curr Neurol Neurosci Rep, 2016, 16(11): 98.
28. Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis. Cochrane Database Syst Rev, 2015, (12): CD002243.
29. Volbeda M, Wetterslev J, Gluud C, et al. Glucocorticosteroids for sepsis: systematic review with meta-analysis and trial sequential analysis. Intensive Care Med, 2015, 41(7): 1220-1234.
30. Venkatesh B, Finfer S, Cohen J, et al. Adjunctive glucocorticoid therapy in patients with septic shock. N Engl J Med, 2018, 378(9): 797-808.
31. Annane D, Renault A, Brun-Buisson C, et al. Hydrocortisone plus fludrocortisone for adults with septic shock. N Engl J Med, 2018, 378(9): 809-818.
32. Ottens TH, Nijsten MW, Hofland J, et al. Effect of high-dose dexamethasone on perioperative lactate levels and glucose control: a randomized controlled trial. Crit Care, 2015, 19: 41.
33. Gorenek B, Pelliccia A, Benjamin EJ, et al. European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS). Europace, 2017, 19(2): 190-225.
34. Jones DP, Patel J. Therapeutic approaches targeting inflammation in cardiovascular disorders. Biology (Basel), 2018, 7: 49.
35. Yanase T, Tajima T, Katabami T, et al. Diagnosis and treatment of adrenal insufficiency including adrenal crisis: a Japan Endocrine Society clinical practice guideline [Opinion]. Endocr J, 2016, 63(9): 765-784.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Adrenal insufficiency after cardiovascular surgery with cardiopulmonary bypass

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