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Stress Hyperglycaemia Mechanism — FRCA Primary MCQ

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HardPhysiology - Endocrine & MetabolicStress Hyperglycaemia MechanismFRCA Primary

A patient with diabetes is fasted for major surgery. Which mechanism contributes most directly to postoperative hyperglycaemia despite no exogenous glucose infusion?

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Correct answer: C — Counter-regulatory hormones increase gluconeogenesis and glycogenolysis

The best answer is “Counter-regulatory hormones increase gluconeogenesis and glycogenolysis”. Catecholamines, cortisol, glucagon and growth hormone promote hepatic glucose production through glycogenolysis and gluconeogenesis, while insulin resistance reduces peripheral disposal. Renal glucose reabsorption may influence glucosuria but is not the immediate generator of stress hyperglycaemia. Increased insulin signalling and reduced sympathetic drive would favour lower glucose.

Reference: RCoA, Primary FRCA syllabus: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf; Surgical stress response: endocrine, immune and metabolic changes: https://pmc.ncbi.nlm.nih.gov/articles/PMC12831963/