Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Endocrine response to surgical stress in three patients over 100 yr

  • 189 Accesses

  • 2 Citations


Purpose: To report the change of plasma epinephrine, norepinephrine, cortisol, plasma renin activity, plasma aldosterone and plasma atrial natriuretic peptide during general anesthesia in three centenarian patients.

Clinical features: Three patients aged 101, 101 and 102-yr, underwent a screw fixation of femoral fracture under general anesthesia. Plasma concentrations of epinephrine, norepinephrine, cortisol, renin activity, aldosterone and atrial natriuretic peptide were measured before the induction of anesthesia, 15 min after incision and 60 min after the end of surgery. Plasma epinephrine concentrations in the three patients increased from 419, 344 and 377 pg·mg−1 before anesthesia to 688, 534 and 478 pg·ml−1 15 min after skin incision. Plasma norepinephrine concentrations increased markedly from 408, 513 and 606 pg·ml−1 before anesthesia to 2950, 1864 and 1574 pg·ml−1 15 min after skin incision. The cortisol response to surgery was similar to that of young adults. Plasma aldosterone and renin activity was low throughout anesthesia. Plasma atrial natriuretic peptide increased from 353, 367 and 109 pg·ml−1 before induction to 479, 487 and 168 pg·ml−1 15 min after skin incision.

Conclusion: Plasma norepinephrine concentration in patients over 10 0yr increased markedly during anesthesia, while plasma renin activity and aldosterone were lower.


Objectif: Rendre compte des changements plasmatiques d’adrénaline, noradrénaline, cortisol, activité rénine, aldostérone et peptide natriurétique aurticulaire pendant l’anesthésie générale de trois patients centenaires.

Éléments cliniques: Trois patients de 101, 101 et 102 ans ont reçu une anesthésie générale pendant la fixation de vis pour une fracture fémorale. Les concentrations plasmatiques d’adrénaline, noradrénaline, cortisol, activité rénine, aldostérone et peptide natriurétique auriculaire ont été mesurées avant l’induction de l’anesthésie, 15 min après l’incision et 60 min après la fin de l’intervention. Les concentrations plasmatiques d’adrénaline ont augmenté chez les trois patients, passant de 419, 344 et 377 pg·ml−1 avant l’anesthésie à 688, 534 et 478 pg·ml−1 15 min après l’incision cutanée. Les concentrations plasmatique de noradrénaline se sont élevées de façon marquée, allant de 408, 513 et 606 pg·ml−1 avant l’anesthésie à 2950, 1864 et 1574 pg·ml−1 15 min après l’incision cutanée. La réponse du cortisol a été similaire à celle qu’on observe chez de jeunes adultes. L’aldostérone plasmatique et l’activité rénine sont demeurées faibles pendant toute l’anesthésie. Les peptides natriurétiques auriculaires sont passés de 353, 367 et 109 pg·ml−1 avant l’induction à 479, 487 et 168 pg·ml−1 15 min après l’incision cutanée.

Conclusion: La concentration plasmatique de noradrénaline a beaucoup augmenté pendant l’anesthésie de patients de plus de 100 ans, tandis que l’activité rénine et l’aldostérone sont demeurées faibles.


  1. 1

    Lehmann M, Keul J. Age-associated changes of exercise-induced plasma catecholamine responses. Eur J Appl Physiol 1986; 55: 302–6.

  2. 2

    de Bold AJ, de Bold ML, Sarda IR. Functional-morphological studies on in vitro cardionatrin release. J Hypertens 1986; 4(Suppl 2): 3–7.

  3. 3

    Tan ACITL, Hoefnagels WHL, Swinkels LMJW, Kloppenborg PWC, Benraad TJ. The effect of volume expansion on atrial natriuretic peptide and cyclic guanosine monophosphate levels in young and aged subjects. J Am Geriatr Soc 1990; 38: 1215–9.

  4. 4

    Kudoh A, Sakai T, Ishihara H, Matsuki A. Renin-aldosterone in elderly patients with hyperkalameia under anaesthesia. Eur J Anaesth 1999; 16: 231–5.

  5. 5

    Kudoh A, Ishihara H, Matsuki A. Response to surgical stress in elderly patients and Alzheimer’s disease. Can J Anesth 1999; 46: 247–52.

  6. 6

    Morrow LA, Linares OA, Hill TJ, et al. Age differences in the plasma clearance mechanisms for epinephrine and norepinephrine in humans. J Clin Endocrinol Metab 1987; 65: 508–11.

  7. 7

    Esler MD, Thompson JM, Kaye DM, et al. Effects of aging on the responsiveness of the human cardaic sympathetic nerves to stressors. Circulation 1995; 91: 351–8.

  8. 8

    Young JB, Rowe JW, Pallotta JA, Sparrow D, Landsberg L. Enhanced plasma norprinephrine response to upright posture and oral glucose administration in elderly human subjects. Metabolism 1980; 29: 532–9.

  9. 9

    Udelsman R, Holbrook NJ. Endocrine and molecular responses to surgical stress. Curr Probl Surg 1994; 31: 655–720.

  10. 10

    Mabry TR, Gold PE, McCarty R Age-related changes in plasma catecholamine responses to chronic intermittent stress. Physiol Behav 1995; 58: 49–56.

  11. 11

    Backlund M, Lapantalo M, Toivonen M, at al. Factors associated with post-operative myocardial ischaemia in elderly patients undergoing major non-cardiac surgery. Eur J Anaesthesiol 1999; 16: 826–33.

  12. 12

    Tarnoky K, Szenohradszky J, Petri G. Plasma catecholamine levels in the postoperative period in complication-free and “paralytic”quo; ileus patients. Acta Chir Hung 1987; 28: 287–98.

  13. 13

    Luft FC, Weinberger MH, Fineberg NS, Miller JZ, Grim CE. Effects of age on renal sodium homoestasis and its relevance to sodium sensitivity. Am J Med 1987; 82(Suppl 1B): 9–15.

  14. 14

    Belmin J, Levy BI, Michel J-B. Changes in the renin-angiotensin-aldosterone axis in later life. Drug Aging 1994; 5: 391–400.

  15. 15

    Tsunoda K, Abe K, Goto T, et al. Effect of age on the renin-angiotensin-aldosterone system in normal subjects: simultaneous measurement of active and inactive renin, renin substrate and aldosterone in plasma. J Clin Endocrinol Metab 1986; 62: 384–9.

  16. 16

    Morimoto S, Uchida K, Miyanaoto M, et al. Plasma aldosterone response to angiotensin II in sodium-restricted elderly subjects with essential hypertension. J Am Geriatr Soc 1981; 29: 302–7.

  17. 17

    Raskind MA, Peskind ER, Halter JB, Jimerson DC. Norepinephrine and MHPG levels in CSF and plasma in Alzheimer disease. Arch Gen Psychiatry 1984; 41: 343–6.

  18. 18

    Davis KL, Davis BM, Greenwald BS, et al. Cortisol and Alzheimer’s Disease. I. Basal studies. Am J Psychiatry 1986; 143: 300–5.

  19. 19

    Martigononi E, Petraglia F, Costa A, Bono G, Genazzani AR, Nappi G. Dementia of the Alzheimer type and hypothalamus-pituitary-adrenocortical axis: changes in cerebrospinal fluid corticotropin releasing factor and plasma cortisol levels. Acta Neurol Scand 1990; 81: 452–6.

Download references

Author information

Correspondence to Akira Kudoh MD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Kudoh, A., Katagai, H. & Takazawa, T. Endocrine response to surgical stress in three patients over 100 yr. Can J Anesth 48, 340–343 (2001). https://doi.org/10.1007/BF03014960

Download citation


  • Aldosterone
  • Atrial Natriuretic Peptide
  • Plasma Renin Activity
  • Femoral Neck Fracture
  • Plasma Aldosterone