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  • Zetterling, MariaUppsala universitet,Neurokirurgi (författare)

Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage

  • Artikel/kapitelEngelska2011

Förlag, utgivningsår, omfång ...

  • 2011-11-24
  • Informa UK Limited,2011
  • printrdacarrier

Nummerbeteckningar

  • LIBRIS-ID:oai:DiVA.org:uu-165676
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-165676URI
  • https://doi.org/10.3109/02688697.2011.584638DOI

Kompletterande språkuppgifter

  • Språk:engelska
  • Sammanfattning på:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • 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.

Ämnesord och genrebeteckningar

  • Subarachnoid haemorrhage
  • cortisol
  • ACTH
  • diurnal variation
  • cerebral oedema

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Edén Engström, BrittUppsala universitet,Institutionen för medicinska vetenskaper(Swepub:uu)brittee (författare)
  • Hallberg, Lena (författare)
  • Hillered, LarsUppsala universitet,Neurokirurgi(Swepub:uu)larshill (författare)
  • Enblad, PerUppsala universitet,Neurokirurgi(Swepub:uu)perenbla (författare)
  • Karlsson, TorbjörnUppsala universitet,Anestesiologi och intensivvård(Swepub:uu)torbkarl (författare)
  • Ronne-Engström, ElisabethUppsala universitet,Neurokirurgi(Swepub:uu)elisronn (författare)
  • Uppsala universitetNeurokirurgi (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:British Journal of Neurosurgery: Informa UK Limited25:6, s. 684-6920268-86971360-046X

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