{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:49:56Z","timestamp":1792788596809,"version":"4.5.0"},"reference-count":36,"publisher":"The Endocrine Society","issue":"11","license":[{"start":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:00:00Z","timestamp":1778716800000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015250","name":"NIHR Bristol Biomedical Research Centre","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100015250","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100007155","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/P014747\/2"],"award-info":[{"award-number":["MR\/P014747\/2"]}],"id":[{"id":"10.13039\/501100007155","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014013","name":"UKRI","doi-asserted-by":"publisher","award":["UKRI12339"],"award-info":[{"award-number":["UKRI12339"]}],"id":[{"id":"10.13039\/100014013","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University of Birmingham Dynamic Investment Fund","id":[{"id":"https:\/\/ror.org\/03angcq70","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Centre for Systems Modelling and Quantitative Biomedicine"},{"DOI":"10.13039\/501100000855","name":"University of Birmingham","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000855","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019573","name":"BHF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100019573","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UK Department of Health and Social Care","id":[{"id":"https:\/\/ror.org\/03sbpja79","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Context<\/jats:title>\n                    <jats:p>The hypothalamic\u2013pituitary\u2013adrenal (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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterize dynamic HPA axis responses in children undergoing cardiac surgery and to determine age- and procedure-related differences in cortisol and cortisone physiology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Neonates 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-\u03b2HSD2 activity and reduced 11-\u03b2HSD1 activity. Low postoperative blood cortisol and CBG values in neonates resulted in high free cortisol peaks in interstitial fluid during and after surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Neonates differ physiologically, with higher free cortisol levels that more readily diffuse into interstitial tissues, with implications for perioperative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1210\/clinem\/dgag206","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T11:43:21Z","timestamp":1778586201000},"page":"3240-3249","source":"Crossref","is-referenced-by-count":1,"title":["The dynamic adrenal response of children to cardiac surgery and cardiac catheterization"],"prefix":"10.1210","volume":"111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6759-7719","authenticated-orcid":false,"given":"Daniel Paul","family":"Fudulu","sequence":"first","affiliation":[{"name":"Bristol Medical School, University of Bristol , Bristol BS8 1TH ,","place":["UK"]},{"name":"Department of Cardiac Surgery, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol BS2 8HW ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Marinelli","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Statistics, University of Exeter , Exeter EX4 4QJ ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Galvis","sequence":"additional","affiliation":[{"name":"National Grid (Avonbank) , Bristol BS2 0TB ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eder","family":"Zavala","sequence":"additional","affiliation":[{"name":"School of Mathematics, University of Birmingham , Birmingham B15 2TT ,","place":["UK"]},{"name":"Centre for Biological Timing; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester , Manchester M13 9PL ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrie","family":"Walker-Smith","sequence":"additional","affiliation":[{"name":"Bristol Trials Centre, University of Bristol , Bristol BS8 2BN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Evans","sequence":"additional","affiliation":[{"name":"Bristol Trials Centre, University of Bristol , Bristol BS8 2BN ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fanoula","family":"Papadopoulou","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospitals Bristol and Weston NHS Foundation Trust , Bristol BS2 8HW 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