Skip to main content
SpringerLink
Log in

Blood levels of atrial natriuretic peptide, endothelin, cortisol and ACTH in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

Abstract

Previous studies demonstrated a bi-phasic time course with post-operative dissociation of blood levels of cortisol and ACTH in patients undergoing major surgery and critically ill patients. A possible role of endothelin and atrial natriuretic peptide (ANP) in the dissociation of concentrations of cortisol and ACTH in critically ill patients has been suggested. In the present study, we investigated the perioperative course of blood levels of endothelin, ANP, ACTH, and cortisol in 13 male patients undergoing cardiac surgery with cardiopulmonary bypass (CPB): group 1 consisted of 7 patients with an uneventful perioperative period and group 2 consisted of 6 patients with perioperative complications. Blood samples were taken pre-[T1], intra-[T2], post-operatively (on the day of surgery) [T3], as well as on the first [T4] and second [T5] post-operative days. Blood samples of endothelin, ANP, cortisol, and ACTH were measured using commercially available immunoassays. Perioperatively, a biphasic time course with post-operative dissociation of ACTH and cortisol concentrations was observed in all patients studied. Intraoperatively, during CPB, the highest levels of endothelin were found. Perioperatively, ANP and endothelin levels were elevated compared to pre-operative values up to the second post-operative day. On the second post-operative day, ANP concentrations were significantly higher in patients with complications in the perioperative period compared to those with an uneventful perioperative period. Our results suggest that: 1) plasma levels of ANP increased in patients with perioperative complications; 2) plasma levels of ANP may have prognostic value for patients undergoing cardiac surgery; and 3) the dissociation of ACTH and cortisol cannot solely be explained by the increase in endothelin-1 and ANP concentrations observed in patients undergoing major surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Naito Y., Fukata J., Tamai S., Seo N., Nakai Y., Mori K., Imura H. Biphasic changes in hypothalamo-pituitary-adrenal function during the early recovery period after major abdominal surgery. J. Clin. Endocrinol. Metab. 1991, 73: 111–117.

    Article  CAS  PubMed  Google Scholar 

  2. Roth-Isigkeit A., Schmucker P. Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery. Steroids 1997, 62: 695–699.

    Article  CAS  PubMed  Google Scholar 

  3. Vermes I., Beishuizen A., Hampsink R.M., Haanen C. Dissociation of plasma adrenocorticotropin and cortisol levels in critically ill patients: possible role of endothelin and atrial natriuretic hormone. J. Clin. Endocrinol. Metab. 1995, 80: 1238–1242.

    CAS  PubMed  Google Scholar 

  4. Jessop D.S. Central non-glucocorticoid inhibitors of the hypothalamo-pituitary-adrenal axis. J. Endocrinol. 1999, 160: 169–180.

    Article  CAS  PubMed  Google Scholar 

  5. Hinson J.P., Vinson G.P., Kapas S., Teja R. The role of endothelin in the control of adrenocortical function: stimulation of endothelin release by ACTH and the effects of endothelin-1 and endothelin-3 on steroidogenesis in rat and human adrenocortical cells. J. Endocrinol. 1991, 128: 275–280.

    Article  CAS  PubMed  Google Scholar 

  6. Calogero A.E., Raiti F., Nicolosi G., Burello N., D’Agata R., Mantero F. Effects of endothelin-1 and endothelin-3 on rat hy-pothalamic corticotropin-releasing hormone and pituitary ACTH release in vitro. J. Endocrinol. 1994, 140: 419–424.

    Article  CAS  PubMed  Google Scholar 

  7. Malendowicz L.K., Nussdorfer G.G., Meneghelli V., Nowak M., Markowska A., Majchrzak M. Effects of endothelin-1 on the rat pituitary-adrenocortical axis under basal and stressful conditions. Endocr. Res. 1997, 23: 349–364.

    Article  CAS  PubMed  Google Scholar 

  8. Vierhapper H., Hollenstein U., Roden M., Nowotny P. Effect of endothelin-1 in manimpact on basal and stimulated concentrations of luteinizing hormone, follicle-stimulating hormone, thyrotropin, growth hormone, corticotropin, and prolactin. Metabolism 1993, 42: 902–906.

    Article  CAS  PubMed  Google Scholar 

  9. Delarue C., Delton I., Fiorini F., Homo-Delarche F., Fasolo A., Braquet P., Vaudri H. Endothelin stimulates steroid secretion by frog adrenal gland in vitro: evidence for the involvement of prostaglandins and extracellular calcium in the mechanism of action of endothelin. Endocrinology 1990, 127: 2001–2008.

    Article  CAS  PubMed  Google Scholar 

  10. Goetz K.L., Wang B.C., Madwed J.B., Zhu J.L., Leadley R.J. Cardiovascular, renal, and endocrine responses to intravenous endothelin in conscious dogs. Am. J. Physiol. Endocrinol. Metab. 1988, 255: R1064–R1068.

    CAS  Google Scholar 

  11. Shirakami G., Segawa H., Shingu K., Saito Y., Magaribuchi T., Nakao K., Mori K. The effects of atrial natriuretic peptide infusion on hemodynamic, renal, and hormonal responses during gastrectomy. Anesth. Analg. 1997, 85: 907–912.

    CAS  PubMed  Google Scholar 

  12. Brenner B.M., Ballermann B.J., Gunning M.E., Zeidel M.L. Diverse biological actions of atrial natriuretic peptide. Physiol. Rev. 1990, 70: 665–699.

    CAS  PubMed  Google Scholar 

  13. Hu R.M., Lewin E.R., Pedram A., Frank H.J.L. Atrial natriuretic peptide inhibits the production and secretion of endothelin from cultured endothelial cells. Mediation through the C receptor. J. Biol. Chem. 1992, 267: 17384–17389.

    CAS  PubMed  Google Scholar 

  14. Espiner E.A. Physiology of natriuretic peptides. J. Intern. Med. 1994, 235: 527–541.

    Article  CAS  PubMed  Google Scholar 

  15. Rubanyi G.M., Polokoff M.A. Endothelins: molecular biology, biochemistry, pharmacology, physiology, and pathophysiology. Pharmacol. Rev. 1994, 46: 325–415.

    CAS  PubMed  Google Scholar 

  16. Fink G., Dow R.C., Casley D., Johnston C.I., Bennie J., Carroll S., Dick H. Atrial natriuretic peptide is involved in the ACTH response to stress and glucocorticoid negative feedback in the rat. J. Endocrinol. 1992, 135: 37–43.

    Article  CAS  PubMed  Google Scholar 

  17. Antoni F.A., Dayanithi G. Guanosine 3′:5′cyclic monophosphate and activators of guanylate cyclase inhibit secretagogue-induced corticotropin release by rat anterior pituitary cells. Biochem. Biophys. Res. Commun. 1989, 158: 824–830.

    Article  CAS  PubMed  Google Scholar 

  18. Kellner M., Wiedemann K., Holsboer F. Atrial natriuretic factor inhibits the CRH-stimulated secretion of ACTH and cortisol in man. Life Sci. 1992, 50: 1835–1842.

    Article  CAS  PubMed  Google Scholar 

  19. Fink G., Dow R.C., Casley D., Johnston C.I., Lim A.T., Copolov D.L., Bennie J., Carroll S., Dick H. Atrial natriuretic peptide is a physiological inhibitor of ACTH release: evidence from immunoneutraliza-tion in vivo. J. Endocrinol. 1991, 131: R9–R12.

    Article  CAS  PubMed  Google Scholar 

  20. Antoni F.A., Hunter E.F.M., Lowry P.J., Noble J.M., Seckl J.R. Atriopeptin: an endogenous corticotropin-release inhibiting hormone. Endocrinology 1992, 130: 1753–1755.

    CAS  PubMed  Google Scholar 

  21. Shito M., Ueda M., Wakabayashi G., Endo M., Kitajima M. Pathophysiological response of cytokines and vasoactive agents in patients undergoing total gastrectomy. Eur. J. Surg. 1998, 164: 115–118.

    Article  CAS  PubMed  Google Scholar 

  22. Tanabe M., Ueda M., Endo M., Kitajima M. Effect of acute lung injury and coexisting disorders on plasma concentrations of atrial natriuretic peptide. Crit. Care Med. 1994, 22: 1762–1768.

    Article  CAS  PubMed  Google Scholar 

  23. Boldt J., Papsdorf M., Uphus D., Müller M., Hempelmann G. Changes in regulators of the circulation in patients undergoing lung surgery. Br. J. Anaesth. 1997, 79: 733–739.

    Article  CAS  PubMed  Google Scholar 

  24. Roth-Isigkeit A., Dibbelt L., Schmucker P. Blood levels of corticosteroid-binding globulin, total cortisol and unbound cortisol in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass. Steroids 2000, 65: 513–520.

    Article  CAS  PubMed  Google Scholar 

  25. Taylor K.M., Bain W.H., Jones J.V., Walker M.S. The effect of hemodilution on plasma levels of cortisol and free cortisol. J. Thorac. Cardiovasc. Surg. 1976, 72: 57–61.

    CAS  PubMed  Google Scholar 

  26. Roth-Isigkeit A., Brechmann J., Dibbelt L., Sievers H.H., Raasch W., Schmucker P. Persistent endocrine stress response in patients undergoing cardiac surgery. J. Endocrinol. Invest. 1998, 21: 12–19.

    Article  CAS  PubMed  Google Scholar 

  27. Roth-Isigkeit A., Dibbelt L., Schmucker P., Seyfarth M. The immune-endocrine interaction varies with the duration of the inflammatory process in cardiac surgery patients. J. Neuroendocrinol. 2000, 12: 546–552.

    Article  CAS  PubMed  Google Scholar 

  28. Geny B., Piquard F., Follenius M., Thiranos J.C., Charpentier A., Epailly E., Levy F., Kretz J.G., Eisenmann B., Haberey P. Endothelin participates in increased circulating atrial natriuretic peptide early after human heart transplantation. J. Heart Lung Transplant. 1998, 17: 167–175.

    CAS  PubMed  Google Scholar 

  29. Pasaoglu I., Erbas B., Varoglu E., Yorgancioglu C., Hazan E., Koray Z., Bekdik C., Bozer Y.A. Changes in the circulating endothelin and atrial natriuretic peptide levels during coronary artery bypass surgery. Jpn. Heart J. 1993, 34: 693–706.

    Article  CAS  PubMed  Google Scholar 

  30. Roth-Isigkeit A., v. Borstel T., Seyfarth M., Schmucker P. Perioperative serum levels of tumour-necrosis-factor alpha (TNF-α), IL-1β, IL-6, IL-10 and soluble IL-2 receptor in patients undergoing cardiac surgery with cardiopulmonary bypass without and with correction for haemodilution. Clin. Exp. Immunol. 1999, 118: 242–246.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Hasdai D., Erez E., Gil-Ad I., Raanani E., Sclarovsky S., Barak Y., Sulkes J., Vidne B.A. Is the heart a source for elevated circulating endothelin levels during aorta-coronary artery bypass grafting surgery in human beings? J. Thorac. Cardiovasc. Surg. 1996, 112: 531–536.

    Article  CAS  PubMed  Google Scholar 

  32. Haak T., Matheis G., Kohleisen M., Ngo H., Beyersdorf F., Usadel K.H. Endothelin during cardiovascular surgery: the effect of diltiazem and nitroglycerin. J. Cardiovasc. Pharmacol. 1995, 26 (Suppl. 3): 5494–5496.

    Google Scholar 

  33. Matheis G., Haak T., Beyersdorf F., Baretti R., Polywka C., Winkelmann B.R. Circulating endothelin in patients undergoing coronary artery bypass grafting. Eur. J. Cardiothorac. Surg. 1995, 9: 269–274.

    Article  CAS  PubMed  Google Scholar 

  34. Mair P., Mair J., Bleier J., Waldenberger F., Furtwaengler W., Balogh D., Puschendorf B. Coronary sinus endothelin-1 concentrations after cardioplegic cardiac arrest. Coron. Artery Dis. 1995, 6: 533–537.

    CAS  PubMed  Google Scholar 

  35. Ferri C., De Marzio P., Desideri G., Baldoncini R., Bellini C., Morelli S., Santucci A. Plasma endothelin-1 levels during transient acute myocardial ischaemia in men: effects of coronary revascularization. Eur. J. Clin. Invest. 1997, 27: 526–532.

    Article  CAS  PubMed  Google Scholar 

  36. Kullmer T., Jungmann E., Haak T., Usadel K.H. Modification of the responses of endothelin-1 to exhaustive physical exercise under stimulated high-altitude conditions with acute hypoxia. Metabolism 1995, 44: 8–9.

    Article  CAS  PubMed  Google Scholar 

  37. Michael J.R., Markewitz B.A., Kohan D.E. Oxidant stress regulates basal endothelin-1 production by cultured rat pulmonary endothelial cells. Am. J. Physiol. 1997, 273: L768–L774.

    CAS  PubMed  Google Scholar 

  38. Hynynen M., Saijonmaa O., Tikkanen I., Heinonen J., Fyhrquist F. Increased plasma endothelin immunoreactivity during cardiopulmonary bypass: a preliminary observation. J. Thorac. Cardiovasc. Surg. 1992, 103: 1024–1025.

    CAS  PubMed  Google Scholar 

  39. Skvorak J.P., Nazian S.J., Dietz J.R. Endothelin acts as a paracrine regulator of stretch-induced atrial natriuretic peptide release. Am. J. Physiol. 1995, 269: R1093–R1098.

    CAS  PubMed  Google Scholar 

  40. Omland T., Aarsland T., Aakvaag A., Lie R.T., Dickstein K. Prognostic value of plasma atrial natriuretic factor, norepinephrine and epinephrine in acute myocar-dial infarction. Am. J. Cardiol. 1993, 72: 255–259.

    Article  CAS  PubMed  Google Scholar 

  41. Omland T., Bonarjee V.V.S., Lie R.T., Caidahl K. Neurohumoral measurements as indicators of long-term prognosis after acute myocardial infarction. Am. J. Cardiol. 1995, 76: 230–235.

    Article  CAS  PubMed  Google Scholar 

  42. Hall C., Rouleau J.L., Moye L., de Champlain J., Bichet D., Klein M., Sussex B., Packer M., Rouleau J., Arnold M.O., Lamas G.A., Sestier F., Gottlieb S.S. Wun C.C., Pfeffer M.A. N-terminal proatrial natriuretic factor. An independent predictor of long-term prognosis after myocardial infarction. Circulation 1994, 89: 1934–1942.

    Article  CAS  PubMed  Google Scholar 

  43. De Groote P., Millaire A., Pigny P., Nugue O., Racadot A., Ducloux G. Plasma levels of atrial natriuretic peptide at peak exercise: a prognostic marker of cardiovascular-related death and heart transplantation in patients with moderate congestive heart failure. J. Heart Lung Transpl. 1997, 16: 956–963.

    Google Scholar 

  44. Hillege H.L., Girbes A.R.J., de Kam P.J., Boomsma F., de Zeeuw D., Charlesworth A., Hampton J.R., van Veldhuisen D.J. Renal function, neurohormonal activation, and survival in patients with chronic heart failure. Circulation 2000, 102: 203–210.

    Article  CAS  PubMed  Google Scholar 

  45. Mulligan R.S., Livesey J.H., Evans M.J., Ellis M.J., Donald R.A. Atrial natriuretic peptide and C-type natriuretic pep-tide do not acutely inhibit the release of adreno-corticotropin from equine pituitary cells in vitro. Neuroendocrinology 1997, 65: 64–69.

    Article  CAS  PubMed  Google Scholar 

  46. Bowman M.E., Robinson P.J., Smith R. Atrial natriuretic peptide, cyclic GMP analogues and modulation of guanylyl cyclase do not alter stimulated POMC peptide release from perifused rat or sheep corticotrophs. J. Neuroendocrinol. 1997, 9: 929–936.

    Article  CAS  PubMed  Google Scholar 

  47. Ambrosi B., Sala C., Bochicchio D., Colombo P., Gazzano G., Fadin C., Morganti A., Faglia G. Effect of atrial natriuretic factor infusion on basal and CRH-stimulated ACTH, cortisol and aldosterone levels in patients with Cushing’s or Addison’s disease. Clin. Endocrinol. (Oxf.) 1994, 40: 589–594.

    Article  CAS  Google Scholar 

  48. Kellner M., Herzog L., Holsboer F., Wiedemann K. Circadian changes in the sensitivity of the corticotropin-releasing hormone-stimulated HPA system after arginine vasopressin and atrial natriuretic hormone in human male controls. Psychoneuroendocrinology 1995, 20: 515–524.

    Article  CAS  PubMed  Google Scholar 

  49. Dallman M.F., Akana S.F., Scribner K.A., Bradbury M.J., Walker C.D., Stark A.M., Cascio C.S. Stress, feedback and facilitation in the hypothalamo-pituitary-adrenal axis. J. Neuroendocrinol. 1992, 4: 517–526.

    Article  CAS  PubMed  Google Scholar 

  50. Bierwolf C., Burgemeister A., Lüthke K., Born J., Fehm H.L. Influence of exogenous atrial natriuretic peptide on the pituitary-adrenal response to corticotropin-releasing hormone and vasopressin in healthy man. J. Clin. Endocrinol. Metab. 1998, 83: 1151–1157.

    Article  CAS  PubMed  Google Scholar 

  51. Yasin S., Costa A., Navarra P., Pozzoli G., Kostoglou-Athanassiou I., Forsling M., Grossman A. Endothelin-1 stimulates the in vitro release of neurohypophyseal hormones, but not corticotropin-releasing hormone, via ETA receptors. Neuroendocrinology 1994, 60: 553–558.

    Article  CAS  PubMed  Google Scholar 

  52. Urquhart J. Adrenal blood flow and adrenocortical response to corticotropin. Am. J. Physiol. 1965, 209: 1162–1168.

    CAS  PubMed  Google Scholar 

  53. Wood C.E., Shinsako M.J., Dallman M.F. Comparison of canine corticosteroid responses to mean and phasic increases in ACTH. Am. J. Physiol. 1982, 242: E102–E108.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, Medical University of Luebeck, Ratzeburger Allee 160, D-23538, Luebeck, Germany

    A. Roth-Isigkeit, W. Eichler, J. Schumacher & P. Schmucker

  2. Department of Clinical Chemistry, Medical University of Luebeck, Luebeck, Germany

    L. Dibbelt

Authors
  1. A. Roth-Isigkeit
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L. Dibbelt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Eichler
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Schumacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Schmucker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Roth-Isigkeit.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roth-Isigkeit, A., Dibbelt, L., Eichler, W. et al. Blood levels of atrial natriuretic peptide, endothelin, cortisol and ACTH in patients undergoing coronary artery bypass grafting surgery with cardiopulmonary bypass. J Endocrinol Invest 24, 777–785 (2001). https://doi.org/10.1007/BF03343927

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03343927

Key-words

Search

Navigation