• Lisa K Taylor, Richard J Auchus, Laurence S Baskin, and Walter L Miller.
• Department of Pediatrics, 513 Parnassus Avenue, University of California, San Francisco, San Francisco, California 94143-0978, USA.
• J. Clin. Endocrinol. Metab. 2013 Sep 1; 98 (9): 3687-93.

BackgroundSupraphysiological "stress dosing" is generally given to adrenally insufficient patients undergoing operative procedures and/or general anesthesia. However, the normal responses of cortisol to surgery are poorly documented, especially in small children. Recent studies in adults suggest that massive glucocorticoid dosing is not needed, especially in minimally invasive surgery.ObjectiveWe sought to characterize the normal cortisol secretion rate in healthy children undergoing minimally and moderately invasive urological procedures.Design And SettingThis was a prospective observational study conducted at a tertiary referral center.PatientsThirty healthy children, ages 5 months to 6 years, were studied undergoing elective urological procedures.MethodsProcedures were performed by a single surgeon; anesthesia was by a standard protocol. Sera were obtained at 5 points: iv catheter placement, intubation, 50% completion of surgery, anesthesia reversal, and 1 hour postoperative. Cortisol and cortisone were quantitated by liquid chromatography-tandem mass spectrometry.ResultsGroup mean cortisol values ranged from 4.21 to 5.71 μg/dL across the 5 time points; none of these mean values differed significantly (P < .05). There were no differences according to age, time of procedure, caudal anesthesia, and moderate vs minimally invasive procedures; 3 patients had higher values. There was a modest diminution in cortisone across the 5 time points.ConclusionsMinimal and moderately invasive urological procedures do not result in a cortisol stress response in healthy children. Peak cortisol levels were seen 1 hour postoperatively. These data suggest that current guidelines for stress dosing in adrenally insufficient patients substantially exceed physiological requirements during minimally invasive procedures.

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