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Cortisol and adreno...
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Zetterling, MariaUppsala universitet,Neurokirurgi
(author)
Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage
- Article/chapterEnglish2011
Publisher, publication year, extent ...
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2011-11-24
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Informa UK Limited,2011
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printrdacarrier
Numbers
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LIBRIS-ID:oai:DiVA.org:uu-165676
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https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-165676URI
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https://doi.org/10.3109/02688697.2011.584638DOI
Supplementary language notes
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Language:English
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Summary in:English
Part of subdatabase
Classification
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
Notes
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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 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.
Subject headings and genre
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Subarachnoid haemorrhage
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cortisol
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ACTH
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diurnal variation
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cerebral oedema
Added entries (persons, corporate bodies, meetings, titles ...)
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Edén Engström, BrittUppsala universitet,Institutionen för medicinska vetenskaper(Swepub:uu)brittee
(author)
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Hallberg, Lena
(author)
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Hillered, LarsUppsala universitet,Neurokirurgi(Swepub:uu)larshill
(author)
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Enblad, PerUppsala universitet,Neurokirurgi(Swepub:uu)perenbla
(author)
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Karlsson, TorbjörnUppsala universitet,Anestesiologi och intensivvård(Swepub:uu)torbkarl
(author)
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Ronne-Engström, ElisabethUppsala universitet,Neurokirurgi(Swepub:uu)elisronn
(author)
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Uppsala universitetNeurokirurgi
(creator_code:org_t)
Related titles
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In:British Journal of Neurosurgery: Informa UK Limited25:6, s. 684-6920268-86971360-046X
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