We demonstrated the dissociation between plasma adrenocorticotropin (ACTH) and serum cortisol levels during the early recovery period after radical gastrectomy in 9 of 31 patients with gastric adenocarcinoma. Patients with the dissociation between plasma ACTH and serum cortisol levels (DAC) showed a sustained elevation of serum cortisol level on the first or second postoperative day, while the plasma ACTH level returned to its preoperative state. These patients also had more advanced cancers (p < 0.05) and suffered from more postoperative complications (p < 0.05) than those without DAC. In these patients with DAC, serum cortisol and interleukin (IL)-6 levels remained higher on the second postoperative day than in those of the patients without DAC (21.80 ± 1.57 vs. 13.68 ± 0.72 μg/dl, p < 0.001, and 74.31 ± 15.65 vs. 18.75 ± 3.14 pg/ml, p < 0.001, respectively). On the second postoperative day, serum IL-6 levels showed a significant correlation with serum cortisol levels in all patients (r = 0.511, p < 0.01). These results suggest that the DAC during the early postoperative period after radical gastrectomy is associated with advanced stage of cancer and postoperative complication, and that the increased serum IL-6 level is at least in part responsible for maintaining the elevated serum cortisol.

Munck A, Guyre PM, Holbrook NJ: Physiological functions of glucocorticoids in stress and their relation to pharmacological actions. Endocr Rev 1984;5:25–44.
Chrousos GP: The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 1995;332:1351–1362.
Ehrhart-Bornstein M, Hinson JP, Bornstein SR, Scherbaum WA, Vinson GP: Intraadrenal interactions in the regulation of adrenocortical steroidogenesis. Endocr Rev 1998;19:101–143.
Reichlin S: Neuroendocrine-immune interactions. N Engl J Med 1993;329:1246–1253.
Van den Berge G, de Zegher F, Bouillon R: Acute and prolonged critical illness as different neuroendocrine paradigms. J Clin Endocrinol Metab 1998;83:1827–1834.
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.
Roth-Isigkeit AK, Schmucker P: Postoperative dissociation of blood levels of cortisol and adrenocorticotropin after coronary artery bypass grafting surgery. Steroids 1997;62:695–699.
Vaughan GM, Becker RA, Allen JP, Goodwin CW Jr, Pruitt BA Jr, Mason AD Jr: Cortisol and corticotrophin in burned patients. J Trauma 1982;22:263–273.
Johansson A, Olsson T, Carlberg B, Karlsson K, Fagerlund M: Hypercortisolism after stroke – partly cytokine-mediated? J Neurol Sci 1997;147:43–47.
Vermes I, Beishuizen A, Hampsink RM, 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.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818–829.
Weber MM, Michl P, Auernhammer CJ, Engelhardt D: Interleukin-3 and interleukin-6 stimulate cortisol secretion from adult human adrenocortical cells. Endocrinology 1997;138:2207–2210.
Mastorakos G, Chrousos GP, Weber JS: Recombinant interleukin-6 activates the hypothalamic-pituitary-adrenal axis in humans. J Clin Endocrinol Metab 1993;77:1690–1694.
Taylor T, Dluhy RG, Williams GH: β-Endorphin suppresses adrenocorticotropin and cortisol levels in normal human subjects. J Clin Endocrinol Metab 1983;57:592–596.
Allolio B, Deuss U, Kaulen D, Leonhardt U, Kallabis D, Hamel E, Winkelmann W: FK 33-824, a met-enkephalin analog, blocks corticotropin-releasing hormone-induced adrenocorticotropin secretion in normal subjects but not in patients with Cushing’s disease. J Clin Endocrinol Metab 1986;63:1427–1431.
Bornstein SR, Chrousos GP: Clinical review 104: Adrenocorticotropin (ACTH)- and non-ACTH-mediated regulation of the adrenal cortex: neural and immune inputs. J Clin Endocrinol Metab 1999;84:1729–1736.
Naito Y, Tamai S, Shingu K, Shindo K, Matsui T, Segawa H, Nakai Y, Mori K: Responses of plasma adrenocorticotropic hormone, cortisol, and cytokines during and after upper abdominal surgery. Anesthesiology 1992;77:426–431.
Baigrie RJ, Lamont PM, Kwiatkowski D, Dallman MJ, Morris PJ: Systemic cytokine response after major surgery. Br J Surg 1992;79:757–760.
Reyes TM, Coe CL: Resistance of central nervous system interleukin-6 to glucocorticoid inhibition in monkeys. Am J Physiol 1998;275:R612–R618.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.