{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T23:30:04Z","timestamp":1777851004358,"version":"3.51.4"},"reference-count":68,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2013,7,17]],"date-time":"2013-07-17T00:00:00Z","timestamp":1374019200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Geriatr Psychiatry Neurol"],"published-print":{"date-parts":[[2013,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>The aim of this study is to determine whether postoperative delirium is associated with dysregulation of hypothalamic\u2013pituitary\u2013adrenal and growth hormone\/insulin-like growth factor 1 (GH\/IGF-1) responses following acute systemic inflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Plasma levels of cortisol, IGF-1, C-reactive protein, interleukin (IL)-6, IL-8, and IL-10 were measured before and after surgery in 101 patients \u226560 years without dementia undergoing elective hip arthroplasty. Participants were assessed with confusion assessment method and Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR) postoperatively and 37 patients fulfilled the DSM-IV-TR criteria for delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Preoperative plasma cortisol levels were similar in delirium and nondelirium groups (405.37 \u00b1 189.04 vs 461.83 \u00b1 219.39; P = .22). Participants with delirium had higher postoperative cortisol levels (821.67 \u00b1 367.17 vs 599.58 \u00b1 214.94; P = .002) with enhanced postoperative elevation in relation to baseline (1.9- vs 1.5-fold; P = .004). The plasma levels of IGF1 did not differ in delirium and nondelirium groups before (18.12 \u00b1 7.58 vs 16.8 \u00b1 7.86; P = .477) and following surgery (13.39 \u00b1 5.94 vs 11.12 \u00b1 6.2; P = .639), but the levels increased in relation to baseline more frequently in patients who developed delirium (24.3% vs 7.8%; P = .034). The magnitude of postoperative cortisol elevation correlated with \u0394IL-6 ( P = .485; P = .002), \u0394IL-8 ( P = .429; P = .008), and \u0394IL-10 ( P = .544; P &lt; .001) only in patients with delirium.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hypothalamic\u2013pituitary\u2013adrenal axis hyperresponsiveness and a less frequent suppression of the GH\/IGF-1 axis in response to acute stress are possibly involved in delirium pathophysiology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0891988713495449","type":"journal-article","created":{"date-parts":[[2013,7,17]],"date-time":"2013-07-17T23:39:10Z","timestamp":1374104350000},"page":"185-194","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":114,"title":["The Stress Response to Surgery and Postoperative Delirium"],"prefix":"10.1177","volume":"26","author":[{"given":"Joaquim","family":"Cerejeira","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Centro Hospitalar Universit\u00e1rio de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal"}]},{"given":"Pedro","family":"Batista","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal"}]},{"given":"Vasco","family":"Nogueira","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Centro Hospitalar Universit\u00e1rio de Coimbra, Coimbra, Portugal"},{"name":"Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal"}]},{"given":"Adriano","family":"Vaz-Serra","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal"}]},{"given":"Elizabeta B.","family":"Mukaetova-Ladinska","sequence":"additional","affiliation":[{"name":"Institute for Ageing and 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