Pantothenic acid, also known as vitamin B5, plays a central role in supporting the body's stress adaptation mechanisms, particularly in the context of surgical recovery. It serves as the metabolic precursor to coenzyme A (CoA), a critical cofactor involved in cortisol biosynthesis, cellular energy metabolism, and lipid processing. Through its impact on hypothalamic–pituitary–adrenal (HPA) axis function, pantothenic acid contributes to a more efficient and balanced physiological response to surgical stress.

In surgical settings, maintaining adequate B5 levels may support adrenal hormone synthesis, helping modulate inflammation and energy requirements during acute recovery phases. Pantothenic acid's rapid cellular turnover also makes it particularly relevant in perioperative nutrition where enhanced neuroendocrine support, metabolic stability, and immunological readiness are desired.

Mechanisms of Action and Benefits

Cortisol Synthesis Support
Pantothenic acid enables the production of coenzyme A, which is essential for the conversion of cholesterol into pregnenolone, the immediate precursor to cortisol. This enzymatic process underlies the synthesis of glucocorticoids needed to regulate inflammation, blood pressure, and glucose metabolism during surgical stress [1–3].

Adrenal Stress Response Modulation
B5 supports adrenal gland function by sustaining CoA-dependent pathways required for hormone production. Its presence helps prevent adrenal depletion and supports recovery from neuroendocrine exhaustion following surgery or critical illness [1,2].

HPA Axis Activation
Pantothenic acid is involved in the body's ACTH-driven cortisol production, helping facilitate the acute phase response during trauma, anesthesia, and surgical intervention. By doing so, it supports homeostasis under metabolic and immunological stress [3,4].

References

1. Anil P, Deepak B, Kumar Y, et al. Harnessing the power of nutritional antioxidants against adrenal hormone imbalance-associated oxidative stress. Front Endocrinol. 2023 Nov 29.
   
2. National Institutes of Health. Pantothenic Acid. In: StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK563233/. Accessed November 2024.
   
3. Gheita AA, Gheita TA, Kenawy SA. The potential role of B5: A stitch in time and switch in cytokine. Phytother Res. 2020;34:306–314.

4. Miller T, Gibbison B, Russell GM. Hypothalamic–pituitary–adrenal function during health, major surgery, and critical illness. BJA Education. 2017;17(1):16–21.