HYPOTHALAMO-PITUITARY RESPONSE BEFORE AND AFTER SURGICAL STRESS (SPLENECTOMY) IN THALASSEMIC PATIENTS

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BANANI S.A.; FOROUTAN H.R.; OMRANI G.H.

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Journal: IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS) Year:2000 | Volume:25 | Issue:1-2 Page(s): 9-14

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Title

HYPOTHALAMO-PITUITARY RESPONSE BEFORE AND AFTER SURGICAL STRESS (SPLENECTOMY) IN THALASSEMIC PATIENTS

Author(s)

BANANI S.A. | FOROUTAN H.R. | OMRANI G.H. | Issue Writer Certificate

Keywords

THALASSEMIA • SURGERY • PITUITARY-ADRENAL SYSTEM • ADRENAL GLANDS • CORTISOL

Abstract

Background/Objective: Multiple endocrinopathy is a common manifestation in thalassemia. Although the response of the stress hormones to induced hypoglycemia has been studied in these patients, the impact of surgical stress is not yet determined. Methods: The hypothalamo-pituitary-adrenal axis of 27 thalassemic patients (TP), [4-15 years old (y.)] admitted for splenectomy, was evaluated before and after surgical stress during 1996-8. Blood samples for measurement of ACTH, cortisol, growth hormone (GH), thyroid stimulating hormone (TSH) and prolactin (PRL) were taken a day before and also approximately two hours after surgical insult. For comparison, 22 non-thalassemic patients (NTP) (3.5-14 y.) admitted for elective laparotomy, were selected as the control group. Results: The cortisol response after surgical stress was significantly higher than baseline in both the TP (17.4 ? 6.3 vs 30.81 ? 11.49 ?g/dl; P<0.00l) and the NTP (20.65 ? 9.1 vs 36.87 ? 11.08 ?g/dl; P<0.001). NTP showed a significant elevation of ACTH upon surgical stress (P<0.001), while the difference between pre- and post-stress ACTH was not statistically significant in TP (P=0.123). However, the ACTH concentration before operation in TP. was significantly higher than that of NTP (P<0.042) with no remarkable difference after surgical stress between the two groups (P=0.261). GH increased significantly after operation in TP and NTP (P< 0.016 and <0.05, respectively). A significant change in TSH (P< 0.03) and PRL (P< 0.004) was also observed in TP after operation. Conclusion: The hypothalamo-pituitary as well as the pituitary-adrenal axes are usually intact and responsive in TP. It is concluded that, the remarkable increase in ACTH concentration before operation may be due to a decreased adrenal reserve. Thus, the possibility of primary partial adrenal insufficiency, particularly under stress situations, should be considered in every thalassemic patient.

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APA: Copy

BANANI, S.A., FOROUTAN, H.R., & OMRANI, G.H.. (2000). HYPOTHALAMO-PITUITARY RESPONSE BEFORE AND AFTER SURGICAL STRESS (SPLENECTOMY) IN THALASSEMIC PATIENTS. IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS), 25(1-2), 9-14. SID. https://sid.ir/paper/275881/en

Vancouver: Copy

BANANI S.A., FOROUTAN H.R., OMRANI G.H.. HYPOTHALAMO-PITUITARY RESPONSE BEFORE AND AFTER SURGICAL STRESS (SPLENECTOMY) IN THALASSEMIC PATIENTS. IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS)[Internet]. 2000;25(1-2):9-14. Available from: https://sid.ir/paper/275881/en

IEEE: Copy

S.A. BANANI, H.R. FOROUTAN, and G.H. OMRANI, “HYPOTHALAMO-PITUITARY RESPONSE BEFORE AND AFTER SURGICAL STRESS (SPLENECTOMY) IN THALASSEMIC PATIENTS,” IRANIAN JOURNAL OF MEDICAL SCIENCES (IJMS), vol. 25, no. 1-2, pp. 9–14, 2000, [Online]. Available: https://sid.ir/paper/275881/en

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