Original Scientific Reports Dehydroepiandrosterone Sulfate and Growth Axis Hormones in Patients after Surgery

We selected 38 patients scheduled for cholecystectomy and studied their serum concentrations of dehydroepiandrosterone (DHEA) and growth axis hormones [growth hormone/insulin-like growth factor-1 (GH/IGF-1)]. We aimed to determine whether alterations in these concentrations resulted from surgical stress or, on the contrary, preceded surgery and were themselves a cause of chronic diseases that reduce life expectancy. We measured the serum concentrations of DHEA sulfate (DHEA-S), ACTH, cortisol, human GH (hGH), IGF-1, and IGF-1 binding protein-3 (IGFBP-3) preoperatively and then 2 and 7 days after surgery; we also compared the preoperative findings with those of a healthy control group. The results were analyzed by gender because DHEA and GH/IGF-1 are known to present sexual dimorphism. There were no significant differences between the preoperative and control results for any of the parameters studied. We found a significant reduction in the concentrations of DHEA-S and IGF-1 on days 2 and 7 after surgery versus the preoperative values. We conclude that the decrease in DHEA-S in patients after surgery is a result of surgical trauma and does not precede surgical stress. The decrease in hormone levels observed in patients with chronic disease may therefore be a result, not a cause, of disease, as some have claimed. Further studies with a later endpoint would be of interest to assess any subsequent return of DHEA-S levels to baseline measurements. Many hormonal changes occur with aging in humans. One of the most intriguing involves the adrenal androgenic steroid dehydroepiandrosterone (DHEA) and its sulfated ester (DHEA-S) [1, 2]. Many epidemiologic studies demonstrated a strong association between the decline in DHEA levels and various age-related disorders. It is important to address whether these epidemiologic data reflect a paraphenomenon or a cause-and-effect relation. Mechanisms that contribute to this shift with aging include the functional decline of the growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis [3]. The possible relation of the GH/IGF-1 axis and DHEA has not been studied, although recent studies have reported that the administration of DHEA resulted in an elevation of IGF-1 levels in the serum of both men and women [4, 5]. Major and moderate surgery represents a physical stress, is one of the most potent activators of the hypothalamic-pituitary-adrenal axis, and alters the GH/IGF-1 axis. In previous papers we have shown that the administration of exogenous human growth hormone (hGH) not only produces an increase in protein synthesis but can also reverse the catabolic response induced by surgical