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Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage.
Br J Neurosurg. 2011 Dec; 25(6):684-92.BJ

Abstract

OBJECTIVE

An adequate response of hypothalamic-pituitary-adrenal (HPA) axis is important for survival and recovery after a severe disease. The hypothalamus and the pituitary glands are at risk of damage after subarachnoid haemorrhage (SAH). A better understanding of the hormonal changes would be valuable for optimising care in the acute phase of SAH.

PATIENTS

Fifty-five patients with spontaneous SAH were evaluated regarding morning concentrations of serum (S)-cortisol and P-adrenocorticotropic hormone (ACTH) 7 days after the bleeding. In a subgroup of 20 patients, the diurnal changes of S-cortisol and P-ACTH were studied and urine (U)-cortisol was measured. The relationships of hormone concentrations to clinical and radiological parameters and to outcome were assessed.

RESULTS

S-cortisol and P-ACTH were elevated the day of SAH. S-cortisol concentrations below reference range were uncommon. Early global cerebral oedema was associated with higher S-cortisol concentrations at admission and a worse World Federation of Neurological Surgeons (WFNS) and Reaction Level Scale 85 grade. Global cerebral oedema was shown to be a predictor of S-cortisol at admittance. Patients in better WFNS grade displayed higher U-cortisol. All patients showed diurnal variations of S-cortisol and P-ACTH. A reversed diurnal variation of S-cortisol was more frequently found in mechanically ventilated patients. Periods of suppressed P-ACTH associated with S-cortisol peaks occurred especially in periods of secondary brain ischaemia.

CONCLUSION

There was an HPA response acutely after SAH with an increase in P-ACTH and S-cortisol. Higher U-cortisol in patients in a better clinical grade may indicate a more robust response of the HPA system. Global cerebral oedema was associated with higher S-cortisol at admission and was a predictor of S-cortisol concentrations. Global cerebral oedema may be the result of the stress response initiated by the brain injury. Periods of suppressed P-ACTH occurred particularly in periods of brain ischaemia, indicating a possible connection between brain ischaemia and ACTH suppression.

Authors+Show Affiliations

Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Sweden. maria.zetterling@telia.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22115015

Citation

Zetterling, Maria, et al. "Cortisol and Adrenocorticotropic Hormone Dynamics in the Acute Phase of Subarachnoid Haemorrhage." British Journal of Neurosurgery, vol. 25, no. 6, 2011, pp. 684-92.
Zetterling M, Engström BE, Hallberg L, et al. Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage. Br J Neurosurg. 2011;25(6):684-92.
Zetterling, M., Engström, B. E., Hallberg, L., Hillered, L., Enblad, P., Karlsson, T., & Ronne Engström, E. (2011). Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage. British Journal of Neurosurgery, 25(6), 684-92. https://doi.org/10.3109/02688697.2011.584638
Zetterling M, et al. Cortisol and Adrenocorticotropic Hormone Dynamics in the Acute Phase of Subarachnoid Haemorrhage. Br J Neurosurg. 2011;25(6):684-92. PubMed PMID: 22115015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage. AU - Zetterling,Maria, AU - Engström,Britt Edén, AU - Hallberg,Lena, AU - Hillered,Lars, AU - Enblad,Per, AU - Karlsson,Torbjörn, AU - Ronne Engström,Elisabeth, PY - 2011/11/26/entrez PY - 2011/11/26/pubmed PY - 2012/2/9/medline SP - 684 EP - 92 JF - British journal of neurosurgery JO - Br J Neurosurg VL - 25 IS - 6 N2 - OBJECTIVE: An adequate response of hypothalamic-pituitary-adrenal (HPA) axis is important for survival and recovery after a severe disease. The hypothalamus and the pituitary glands are at risk of damage after subarachnoid haemorrhage (SAH). A better understanding of the hormonal changes would be valuable for optimising care in the acute phase of SAH. PATIENTS: Fifty-five patients with spontaneous SAH were evaluated regarding morning concentrations of serum (S)-cortisol and P-adrenocorticotropic hormone (ACTH) 7 days after the bleeding. In a subgroup of 20 patients, the diurnal changes of S-cortisol and P-ACTH were studied and urine (U)-cortisol was measured. The relationships of hormone concentrations to clinical and radiological parameters and to outcome were assessed. RESULTS: S-cortisol and P-ACTH were elevated the day of SAH. S-cortisol concentrations below reference range were uncommon. Early global cerebral oedema was associated with higher S-cortisol concentrations at admission and a worse World Federation of Neurological Surgeons (WFNS) and Reaction Level Scale 85 grade. Global cerebral oedema was shown to be a predictor of S-cortisol at admittance. Patients in better WFNS grade displayed higher U-cortisol. All patients showed diurnal variations of S-cortisol and P-ACTH. A reversed diurnal variation of S-cortisol was more frequently found in mechanically ventilated patients. Periods of suppressed P-ACTH associated with S-cortisol peaks occurred especially in periods of secondary brain ischaemia. CONCLUSION: There was an HPA response acutely after SAH with an increase in P-ACTH and S-cortisol. Higher U-cortisol in patients in a better clinical grade may indicate a more robust response of the HPA system. Global cerebral oedema was associated with higher S-cortisol at admission and was a predictor of S-cortisol concentrations. Global cerebral oedema may be the result of the stress response initiated by the brain injury. Periods of suppressed P-ACTH occurred particularly in periods of brain ischaemia, indicating a possible connection between brain ischaemia and ACTH suppression. SN - 1360-046X UR - https://www.unboundmedicine.com/medline/citation/22115015/Cortisol_and_adrenocorticotropic_hormone_dynamics_in_the_acute_phase_of_subarachnoid_haemorrhage_ L2 - https://www.tandfonline.com/doi/full/10.3109/02688697.2011.584638 DB - PRIME DP - Unbound Medicine ER -