The cortisol stress response following surgery for proximal femur fractures in geriatric patients – a prospective pilot study
By
Menger, Maximilian M.
Streck, Laura E.
Braun, Benedikt J.
Herath, Steven C.
Audretsch, Christof K.
Bamberg, Maximilian
Menger, Michael D.
Histing, Tina
Fontana, Johann
March 30, 2026
Clinical Scorecard: Cortisol Stress Response After Surgery for Proximal Femur Fractures in Elderly Patients: A Prospective Pilot Investigation
At a Glance
Category Detail
Condition Proximal Femur Fractures in Elderly Patients Key Mechanisms Impaired adrenocortical circadian rhythmicity affecting cortisol stress response Target Population Geriatric patients aged > 70 years Care Setting Intensive Care Unit (ICU) of a level I trauma center
Key Highlights
35% of patients exhibited cortisol levels below the critical threshold of 276 nmol/L Significant correlation between IL-6 levels and cortisol response Procalcitonin, leukocyte count, and CRP showed no predictive value for cortisol levels Postoperative cortisol monitoring is recommended for geriatric patients IL-6 may serve as a marker for monitoring postoperative endocrine stress response Guideline-Based Recommendations
Diagnosis
Monitor cortisol levels postoperatively in geriatric patients with proximal femur fractures Management
Consider hydrocortisone administration for patients with attenuated cortisol response Monitoring & Follow-up
Use IL-6 as a potential marker for endocrine stress response monitoring Risks
Relative cortisol insufficiency may contribute to postoperative complications and increased mortality Patient & Prescribing Data
Elderly patients aged over 70 years with proximal femur fractures
Timely initiation of treatment may improve outcomes in patients with low cortisol levels
Clinical Best Practices
Regularly assess cortisol levels in geriatric trauma patients post-surgery Implement early intervention strategies for patients identified with critical illness-related corticosteroid insufficiency References
