Skip to main content
SpringerLink
Log in

Acute changes in circulating hormones in older patients with impaired ventricular function undergoing on-pump coronary artery bypass grafting

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

Abstract

Objectives: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) causes an acute stress response characterized by changes in the levels of several hormones, which might play a role in the high complication rate experienced by older patients after CABG. Thus, the aim of the study was to investigate changes in the circulating levels of anabolic and catabolic hormones in old people undergoing CABG with CPB. Design: Intervention case study. Methods: 19 patients (12 males, 7 females) aged 70.1 ± 6.1 yr (age range 62–80) with coronary artery disease and an ejection fraction <40% who underwent cardiac surgery. Cortisol (Cort), DHEA, DHEAS, LH, estradiol (E2), total testosterone (Te), SHBG, IGF-I were measured the day before, on the day of the procedure and 1, 2, 3, 4, and 30 days after CABG. Results: After surgery, serum IGF-I levels decreased (p<0.001), while levels of Cort, DHEAS and E2 significantly increased in both men and women. Alterations in Te levels differed between the two sexes with a significant decline in men and a significant increment in women. Conclusion: CABG with CPB resulted in a dramatic drop in Te levels in old men and a significant decline in IGF-I in both sexes. Serum Cort levels also significantly increased in both sexes. These hormonal changes may, at least partially, explain why the elderly need prolonged rehabilitation after CABG.

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

Access this article

Log in via an institution

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. Lunenfeld B. Replacement therapy in the aging male. J Endocrinol Invest 2002, 10 (Suppl): 2–9.

    Google Scholar 

  2. Valenti G. Adrenopause: an imbalance between dehydroe-piandrosterone (DHEA) and cortisol secretion. J Endocrinol Invest 2002, 10 (Suppl): 29–35.

    Google Scholar 

  3. Roubenoff R, Parise H, Payette HA, et al. Cytokines, insulin-like growth factor-1, sarcopenia and mortality in very old community-dwelling men and women: the Framingham heart study. Am J Med 2003, 115: 429–35.

    Article  PubMed  CAS  Google Scholar 

  4. Ceda GP, Dall’Aglio E, Salimbeni I, et al. Pituitary function in chronic heartfailure in the elderly. J Endocrinol Invest 2002, 10 (Suppl): 24–8.

    Google Scholar 

  5. Ferrucci L, Guralnik JM. Inflammation, hormones, and body composition at a crossroad. Am J Med 2003, 115: 501–2.

    Article  PubMed  Google Scholar 

  6. Muller M, van der Schouw YT, Thijssen JHH, et al. Endogenous sex hormones and cardiovascular disease in men. J Clin Endocrinol Metab 2003, 88: 5076–86.

    Article  PubMed  CAS  Google Scholar 

  7. Saccà L, Cittadini A, Fazio S. Growth hormone and the heart. Endocr Rev 1994, 15: 555–73.

    Article  PubMed  Google Scholar 

  8. Vasan RS, Sullivan LM, D’Agostino RB, et al. Serum Insulin-like Growth Factor I and Risk for Heart Failure in Elderly Individuals without a Previous Myocardial Infarction: The Framingham Heart Study. Ann Intern Med 2003, 139: 642–8.

    Article  PubMed  CAS  Google Scholar 

  9. Tengstrand B, Carlstrom K, Hafstrom I. Bioavailable testosterone in men with rheumatoid arthritis-high frequency of hypogonadism. Rheumatology 2002, 41: 285–9.

    Article  PubMed  CAS  Google Scholar 

  10. Ferrari E, Cravello L, Muzzoni B, et al. Age-related changes of the hypothalamic-pituitary-adrenal axis: pathophysiologi-cal correlates. Eur J Endocrinol 2001, 144: 319–29.

    Article  PubMed  CAS  Google Scholar 

  11. Kudielka BM, Schmidt-Reinwald AK, Hellhammer DH, Kirschbaum C. Psychological and endocrine responses to psychosocial stress and dexamethasone/corticotropin-releasing hormone in healthypostmenopausal women and young controls: the impact of age and a two-week estradiol treatment. Neuroendocrinology 1999, 70: 422–30.

    Article  PubMed  CAS  Google Scholar 

  12. Butcher SK, Lord JM. Stress responses and innate immunity: aging as a contributory factor. Aging Cell 2004, 3: 151–60.

    Article  PubMed  CAS  Google Scholar 

  13. Straub RH, Lehle K, Herfarth H, et al. Dehydroepiandroster-one in relation to other adrenal hormones during an acute inflammatory stressful disease state compared with chronic inflammatory disease: role of interleukin-6 and tumour necrosis factor. Eur J Endocrinol 2002, 146: 365–74.

    Article  PubMed  CAS  Google Scholar 

  14. Velissaris T, Tang AT, Murray M, et al. A prospective randomized study to evaluate stress response during beating-heart and conventional coronary revascularization. Ann Thorac Surg 2004, 78: 506–12.

    Article  PubMed  Google Scholar 

  15. Wei M, Kuukasjarvi P, Laurikka J, et al. Imbalance of pro-and anti-inflammatory cytokine responses in elderly patients after coronary artery bypass grafting. Aging Clin Exp Res 2003, 15: 469–74.

    Article  PubMed  CAS  Google Scholar 

  16. Eagle KA, Guyton RA, Davidoff R, et al. American College of Cardiology; American Heart Association; ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004, 110: 340–437.

    Article  Google Scholar 

  17. Conaway DG, House J, Bandt K, Hayden L, Borkon AM, Spertus JA. The elderly: health status benefits and recovery of function one year after coronary artery bypass surgery. J Am Coll Cardiol 2003, 42: 1421–6.

    Article  PubMed  Google Scholar 

  18. Greenfield S, Aronow HU, Elashoff RM, Watanabe D. Flaws in mortality data: the hazard of ignoring comorbid disease. JAMA 1988, 260: 2253.

    Article  PubMed  CAS  Google Scholar 

  19. Nashef SA, Roques F, Michel P, et al European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg 1999, 16: 9–13.

    Article  PubMed  CAS  Google Scholar 

  20. Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis related organ failure assessment) score to describe organ dysfunction failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996, 22: 707–10.

    Article  PubMed  CAS  Google Scholar 

  21. Canbaz S, Ege T, Sunar H, Cikirikcioglu M, Acipayam M, Duran E. The effects of cardiopulmonary bypass on androgen hormones in coronary artery bypass surgery. J Int Med Res 2002, 30: 9–14.

    Article  PubMed  CAS  Google Scholar 

  22. Lanuza DM. Postoperative circadian rhythms and cortisol stress response to two types of cardiac surgery. Am J Crit Care 1995, 4: 212–20.

    PubMed  CAS  Google Scholar 

  23. Roth-Isigkeit A, Schmucker P. Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery. Steroids 1997, 62: 695–9.

    Article  PubMed  CAS  Google Scholar 

  24. Roth-Isigkeit A, Brechmann J, Dibbelt L, Sievers HH, Raasch W, Schmucker P. Persistent endocrine stress response in patients undergoing cardiac surgery. J Endocrinol Invest 1998, 21: 12–9.

    Article  PubMed  CAS  Google Scholar 

  25. Vermeulen A, Kaufman JM. Ageing of the hypotha-lamo-pituitary testicular axis in men. Horm Res 1995, 43: 25–8.

    Article  PubMed  CAS  Google Scholar 

  26. Aono T, Kurachi K, Mizutani S, et al. Influence of major surgical stress on plasma levels of testosterone, luteinizing hormone and follicle-stimulating hormonein male patients. J Clin Endocrinol Metab 1972, 35: 535–42.

    Article  PubMed  CAS  Google Scholar 

  27. Matsumoto AM. Andropause: clinical implications of the decline in serum testosterone levels with aging in men. J Gerontol A Biol Sci Med Sci 2002, 57: M76–99.

    Article  PubMed  Google Scholar 

  28. Finkelstein JS, O’Dea LS, Whitcomb RW, Crowley WF Jr. Sex steroid control of gonadotropin secretion in the human male. II. Effects of estradiol administration in normal and gonadotropin releasing hormone deficient men. J Clin Endocrinol Metab 1991, 73: 621–8.

    Article  PubMed  CAS  Google Scholar 

  29. Dong Q, Salva A, Sottas CM, Niu E, Holmes M, Hardy MP. Rapid glucocorticoid mediation of suppressed testosterone biosynthesis in male mice subjected to immobilization stress. J Androl 2004, 25: 973–81.

    PubMed  CAS  Google Scholar 

  30. Mauduit C, Gasnier F, Rey C, et al. TNF alfa inhibits leydig cell steroidogenesis through a decrease in steroidogenic acute regulatory protein expression. Endocrinology 1998, 139: 2863–8.

    PubMed  CAS  Google Scholar 

  31. Mortola JF,Yen SS. The effects of oral dehydroepiandroster-one on endocrine metabolic parameters in postmenopausal women. J Clin Endocrinol Metab 1990, 71: 696–704.

    Article  PubMed  Google Scholar 

  32. Laughlin GA, Barrett-Connor E, Kritz-Silverstein D, von Muhlen D. Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study. J Clin Endocrinol Metab 2000, 85: 645–51.

    PubMed  CAS  Google Scholar 

  33. Cavaliere F, Guarnieri S, Varano C, Di Francesco P, Possati GF, Schiavello R. Somatomedin-C plasma levels after coronary revascularization. J Cardiovasc Surg 1992, 33: 761–4.

    CAS  Google Scholar 

  34. Wallin M, Barr G, Wall A, Lindahl SG, Brismar K. The influence of glucose-insulin-potassium (GIK) on the GH/IGF-I/ IGFBP-1 axis during elective coronary artery bypass surgery. J CardiothoracVasc Anesth 2003, 17: 470–7.

    Article  Google Scholar 

  35. Balcells J, Moreno A, Audi L, Roqueta J, Iglesias J, Carras-Cosa A. Growth hormone/insulin-like growth factors axis in children undergoing cardiac surgery. Crit Care Med 2001, 29: 1234–8.

    Article  PubMed  CAS  Google Scholar 

  36. Lang CH, Nystrom GJ, Frost RA. Regulation of IGF binding protein-1 in hep G2 cells by cytokines and reactive oxygen species. Am J Physiol 1999, 276: G719–27.

    PubMed  CAS  Google Scholar 

  37. Lang CH, Hong-Brown L, Frost RA. Cytokine inhibition of JAK-STAT signaling: a new mechanism of growth hormone resistance. Pediatr Nephrol 2005, 20: 306–12.

    Article  PubMed  Google Scholar 

  38. Trotter A, Grill HJ, Hemmer W, Hannekum A, Lang D. Sex steroids in cardiopulmonary bypass. Crit Care 1997, 1: 85–7.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Wei M, Kuukasjarvi P, Kaukinen S, et al. Anti-inflammatory effects of 17 beta-estradiol pretreatment inmen after coronary artery surgery. J Cardiothorac Vasc Anesth 2001, 15: 455–9.

    Article  PubMed  CAS  Google Scholar 

  40. Nussmeier NA, Marino MR, Vaughn WK. Hormone replacement therapy is associated with improved survival in women undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 2002, 124: 1225–9.

    Article  PubMed  CAS  Google Scholar 

  41. Tsuda K, Nishio I. Sex hormones and membrane microvis-cosity in elderly women. Circulation 2004, 109: 218.

    Article  Google Scholar 

  42. Valenti G, Banchini A, Denti L, Maggio M, Ceresini G, Ceda GP. Acute oral administration of dehydroepiandrosterone in male subjects: effect of age on bioavailability, sulfoconjugation and bioconversion in other steroids. J Endocrinol Invest 1999, 22(Suppl 10): 24–8.

    PubMed  CAS  Google Scholar 

  43. Absalom A, Pledger D, Kong A. Adrenocortical function in critically ill patients 24 h after a single dose of etomidate. Anaesthesia 1999, 54: 861–7.

    Article  PubMed  CAS  Google Scholar 

  44. Anker SD, Chua TP, Ponikowski P, et al. Hormonal changes and catabolic/anabolic imbalance in chronic heart failure and their importance for cardiac cachexia. Circulation 1997, 96: 526–34.

    Article  PubMed  CAS  Google Scholar 

  45. Longcope C, Baker R, Johnston CC Jr. Androgen and estrogen metabolism: relationship to obesity. Metabolism 1986, 35: 235–7.

    Article  PubMed  CAS  Google Scholar 

  46. Kajantie E, Fall CH, Seppala M, et al. Serum insulin-like growth factor (IGF)-I and IGF-binding protein-1 in elderly people: relationships with cardiovascular risk factors, body composition, size at birth, and childhood growth. J Clin Endocrinol Metab 2003, 88: 1059–65.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging (NIA), National Institutes of Health (NIH), USA

    M. Maggio & L. Ferrucci MD, PhD

  2. Department of Medicine, Division of Endocrinology, Johns Hopkins University School of Medicine, Bayview Medical Center, Baltimore, MD, USA

    S. Basaria

  3. Cardiac Surgery Unit, Civil Hospital, Brescia

    G. De Cicco

  4. Section of Geriatrics, Department of Internal Medicine and Biomedical Sciences, Italy

    G. P. Ceda, E. Cattadori, S. Visioli, F. Ablondi, G. Ceresini & G. Valenti

  5. Department of Cardiac Surgery and Cardiology, University of Parma, Parma, Italy

    C. Beghi & T. Gherli

Authors
  1. M. Maggio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. P. Ceda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. G. De Cicco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Cattadori
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Visioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Ablondi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. C. Beghi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. T. Gherli
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Basaria
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. Ceresini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. G. Valenti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. L. Ferrucci MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Ferrucci MD, PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maggio, M., Ceda, G.P., De Cicco, G. et al. Acute changes in circulating hormones in older patients with impaired ventricular function undergoing on-pump coronary artery bypass grafting. J Endocrinol Invest 28, 711–719 (2005). https://doi.org/10.1007/BF03347554

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03347554

Keywords

Search

Navigation