Dissociation of Thyrotropin and Leptin Secretion in Acute Surgical Stress in Severely Obese Patients
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CLINICAL RESEARCH
Dissociation of Thyrotropin and Leptin Secretion in Acute Surgical Stress in Severely Obese Patients Marina Michalaki & Apostolos G. Vagenakis & Marianna Argentou & Panagiotis Mylonas & Fotis Kalfarentzos & Venetsana Kyriazopoulou
Received: 5 January 2009 / Accepted: 27 April 2009 / Published online: 20 May 2009 # Springer Science + Business Media, LLC 2009
Abstract Background During illness, thyroid parameters undergo acute changes, which are known as non-thyroidal illness syndrome, the cause of which has not been elucidated. In vitro and in vivo data demonstrate that leptin regulates the expression of thyrotropin-releasing hormone (TRH)— mRNA in the paraventricular nucleus as well as the secretion of thyrotropin (TSH) in response to fasting in humans and animals. Moreover, in healthy adults, TSH and leptin have almost identical circadian rhythms. Our aim was to investigate the secretion of leptin and TSH, and their probable interaction, during the acute stress that is induced by surgery. Methods We studied 18 severely obese but otherwise healthy men. All participants were admitted to the hospital in the morning after an overnight fast. On the following day, 14 of the participants underwent bariatric surgery at 0900. The remaining four participants did not undergo surgery and served as controls. Serum samples to measure the levels of TSH and leptin were collected from all participants, as follows: upon admission to the hospital (baseline values) and on the following day at 0900 and every 10 min, thereafter for 9 h. M. Michalaki (*) : A. G. Vagenakis : P. Mylonas : V. Kyriazopoulou Department of Internal Medicine, Division of Endocrinology, University Hospital, Rion-Patras, Greece e-mail: [email protected] M. Argentou : F. Kalfarentzos Division of Nutritional Support and Morbid Obesity, University Hospital Patras, Patras, Greece
Results The serum TSH increased during the first hour after skin incision (si) and then decreased gradually throughout the rest of the observation period. In contrast, during the first hour after si, the leptin levels remained unaltered. The leptin levels then decreased and reached a nadir at 4 h and 10 min post si after which they remained constant for approximately 1 h. Thereafter, while TSH continued to decrease, leptin started to increase and reached baseline values at 9 h post si. In control subjects, the TSH and leptin profiles seemed parallel each other. Conclusions During acute surgical stress, the secretion of TSH and leptin in severely obese men is asynchronous and causality could not be proven. Keywords TSH . Leptin . Severe obesity . Surgery . Non-thyroidal illness syndrome . Acute stress
Introduction During systemic illness, starvation, trauma, or surgery profound alterations occur in hypothalamus–pituitary– thyroid (HPT) axis these changes are known as the «nonthyroidal illness syndrome» [1].The most common abnormalities in the syndrome are a decrease in triiodothyronine (T3) and an increase in reverse T3 (rT3), which are observed within hours of the o
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