Evidence map›Paper›PMID 42128807›Full record

ArticleThe Journal of clinical endocrinology and metabolism2026

The dynamic adrenal response of children to cardiac surgery and cardiac catheterization.

Daniel Paul Fudulu, Isabella Marinelli, Daniel Galvis, Eder Zavala, Terrie Walker-Smith, Jonathan Evans, Fanoula Papadopoulou, Thomas Upton, Aravind Ramesh, Filippo Rapetto and 15 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Journal of clinical endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. The dynamic adrenal response of children to cardiac surgery and cardiac catheterization.The Journal of clinical endocrinology and metabolism · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

25 authors.

Daniel Paul FuduluBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.ORCID 0000-0001-6759-7719
Isabella MarinelliDepartment of Mathematics and Statistics, University of Exeter, Exeter EX4 4QJ, UK.
Daniel GalvisNational Grid (Avonbank), Bristol BS2 0TB, UK.
Eder ZavalaSchool of Mathematics, University of Birmingham, Birmingham B15 2TT, UK.
Terrie Walker-SmithBristol Trials Centre, University of Bristol, Bristol BS8 2BN, UK.
Jonathan EvansBristol Trials Centre, University of Bristol, Bristol BS8 2BN, UK.
Fanoula PapadopoulouDepartment of Cardiac Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, UK.
Thomas UptonBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Aravind RameshBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Filippo RapettoDepartment of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, Genova 16132, Italy.
Yvonne KershawBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Jan FoxBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Angela AramburoDepartment of Paediatric Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.
Serban Constantin StoicaBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Massimo CaputoBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Andrew ParryBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Duncan MacraeDepartment of Paediatric Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.
Guido MichielonCongenital Heart Surgery & Heart Department, IRCSS Gaslini Children's Hospital, Genova 16147, Italy.
Johann Andreas HoschtitzkyDepartment of Paediatric Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, London SW3 6NP, UK.
Karen SheehanDepartment of Cardiac Surgery, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol BS2 8HW, UK.
Martijn van FaassenDepartment of Laboratory Medicine, University of Groningen, 9713 GZ Groningen, Netherlands.ORCID 0000-0002-9142-6263
Ido KemaDepartment of Laboratory Medicine, University of Groningen, 9713 GZ Groningen, Netherlands.
Gianni Davide AngeliniBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Stafford LightmanBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.
Ben GibbisonBristol Medical School, University of Bristol, Bristol BS8 1TH, UK.ORCID 0000-0003-3635-6212

Funding

BHFBritish Heart FoundationCentre for Systems Modelling and Quantitative BiomedicineMedical Research Council MR/P014747/2NIHRNIHR Bristol Biomedical Research CentreUK Department of Health and Social CareUKRI UKRI12339University of BirminghamUniversity of Birmingham Dynamic Investment Fund
6 · The paper itself

Abstract

contextThe hypothalamic-pituitary-adrenal (HPA) axis is the key homeostatic system regulating the response to surgical stress. Imbalances in HPA axis hormones increase morbidity and mortality in children after cardiac surgery. Despite this, the physiology of the HPA axis in children undergoing cardiac surgery is poorly understood, leading to controversies in clinical practice.

objectiveTo characterize dynamic HPA axis responses in children undergoing cardiac surgery and to determine age- and procedure-related differences in cortisol and cortisone physiology.

methodsWe recruited children (0-18 years) undergoing cardiac surgery with cardiopulmonary bypass or cardiac catheterization. Tissue-free cortisol and cortisone were sampled every 20 minutes for up to 24 hours via microdialysis, alongside serum adrenocorticotropic hormone (ACTH), cortisol, cortisol-binding globulin (CBG), and inflammatory markers. We developed dynamic markers to quantify age- and procedure-dependent differences in hormonal responses and built a mathematical model to explain them.

resultsNeonates undergoing surgery showed higher free cortisol and cortisone AUC and peak concentrations than catheterization patients. Neonates had higher peaks of cortisol and cortisone than older children undergoing surgery. The much higher tissue cortisone levels observed in neonates can be explained by enzymatic interconversion between cortisol and cortisone, likely due to persistent fetal high 11-βHSD2 activity and reduced 11-βHSD1 activity. Low postoperative blood cortisol and CBG values in neonates resulted in high free cortisol peaks in interstitial fluid during and after surgery.

conclusionNeonates differ physiologically, with higher free cortisol levels that more readily diffuse into interstitial tissues, with implications for perioperative management.

Indexed as

Cardiac CatheterizationCardiac Surgical ProceduresHypothalamo-Hypophyseal SystemPituitary-Adrenal SystemAdolescentAdrenocorticotropic HormoneCardiopulmonary BypassChildChild, PreschoolCortisoneFemaleHumansHydrocortisoneInfantInfant, NewbornMaleAdrenocorticotropic HormoneCortisoneHydrocortisonedynamic markersglucocorticoid dynamicsHPA axismathematical modelingpediatric cardiac surgery

Identifiers

PMID42128807
PMCPMC13671769

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.