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Cortisol and ACTH d...
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Zetterling, Maria,1966-Uppsala universitet,Neurokirurgi
(author)
Cortisol and ACTH dynamics in the acute phase of subarachnoid haemorrhage
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LIBRIS-ID:oai:DiVA.org:uu-128968
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-128968URI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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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 optimizing care in the acute phase of SAH. Patients: 55 patients with spontaneous SAH were evaluated regarding morning levels of S-Cortisol and P-ACTH seven days after the bleeding. In a subgroup of 20 patients the diurnal changes of S-Cortisol and P-ACTH levels were studied and U-Cortisol measured. The relations of hormone levels to clinical and radiological parameters and to outcome were assessed. Results: S-Cortisol and P-ACTH were elevated the day of SAH. S-Cortisol levels below reference range were uncommon. Early global cerebral oedema was associated with higher S-Cortisol concentrations at admission and a worse WFNS and RLS85 grade. Patients in better WFNS grade had higher U-Cortisol levels. All patients showed diurnal variations of S-Cortisol and P-ACTH. A reversed diurnal variation of S-Cortisol was more frequently seen in mechanically ventilated patients. Periods of suppressed P-ACTH associated with S-Cortisol peaks occurred especially in periods of secondary brain ischemia. Conclusion: There is a HPA response acutely after SAH with an increase of P-ACTH and S-Cortisol levels. Higher U-Cortisol levels 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 levels at admission and may be the result of the stress response initiated by the brain injury. Periods of suppressed P-ACTH occurred particularly in periods of brain ischemia, indicating a possibly connection between brain ischemia and ACTH suppression. These two novel findings should be evaluated in further studies.
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Edén Engström, BrittUppsala universitet,Medicin
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Hallberg, LenaDepartment of Radiology, Karolinska University Hospital, Huddinge
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Hillered, LarsUppsala universitet,Neurokirurgi
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Enblad, PerUppsala universitet,Neurokirurgi
(author)
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Karlsson, TorbjörnUppsala universitet,Anestesiologi och intensivvård
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Ronne Engström, ElisabethUppsala universitet,Neurokirurgi
(author)
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Uppsala universitetNeurokirurgi
(creator_code:org_t)
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In:British Journal of Neurosurgery0268-86971360-046X
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