Hormonal response to surgical stress in prepubertal children

The hormonal response to stress has not been previously studied in prepubertal children. We determined plasma cortisol, growth hormone (GH), prolactin, insulin, and glucose prior to anesthesia, 10 min after induction of anesthesia, 10 min after surgery began, and 60 min after anesthesia and surgery had ended, in 14 healthy children aged 5–9 years undergoing elective surgical procedures. Blood glucose rose significantly during surgery without a synchronous rise in insulin, which increased only in the immediate postoperative period. Prolactin values increased during anesthesia, remained high during surgery, and started to decline in the postoperative period. Cortisol also rose during anesthesia but remained at high levels throughout the study period. GH did not change during anesthesia; it increased during surgery and continued to rise during the postoperative period. In some children relatively high levels of cortisol or prolactin were detected preoperatively, possibly caused by psychological stress. The findings indicate that profound hormonal changes occur in prepubertal healthy children after even minor surgical procedures. This knowledge may lead to measures that could improve the outcome in sick or metabolically abnormal children undergoing surgical procedures.Offprint requests to: C. Dacou-Voutetakis