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Cortisol and ACTH d...
Cortisol and ACTH dynamics in the acute phase of subarachnoid haemorrhage
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- Zetterling, Maria, 1966- (författare)
- Uppsala universitet,Neurokirurgi
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- Edén Engström, Britt (författare)
- Uppsala universitet,Medicin
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- Hallberg, Lena (författare)
- Department of Radiology, Karolinska University Hospital, Huddinge
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visa fler...
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- Hillered, Lars (författare)
- Uppsala universitet,Neurokirurgi
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- Enblad, Per (författare)
- Uppsala universitet,Neurokirurgi
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- Karlsson, Torbjörn (författare)
- Uppsala universitet,Anestesiologi och intensivvård
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- Ronne Engström, Elisabeth (författare)
- Uppsala universitet,Neurokirurgi
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visa färre...
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(creator_code:org_t)
- Engelska.
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Ingår i: British Journal of Neurosurgery. - 0268-8697 .- 1360-046X.
- Relaterad länk:
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https://urn.kb.se/re...
Abstract
Ämnesord
Stäng
- 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Nyckelord
- Subarachnoid haemorrhage
- Cortisol
- ACTH
- Diurnal variation
- Cerebral oedema
- Neurosurgery
- Neurokirurgi
- Neurosurgery
- Neurokirurgi
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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