Cortisol and ACTH dynamics in the acute phase of subarachnoid haemorrhage

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Fältnamn	Indikatorer	Metadata
000		03652naa a2200421 4500
001		oai:DiVA.org:uu-128968
003		SwePub
008		100804\| \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
024	7	a https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-1289682 URI
040		a (SwePub)uu
041		a engb eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Zetterling, Maria,d 1966-u Uppsala universitet,Neurokirurgi4 aut
245	1 0	a Cortisol and ACTH dynamics in the acute phase of subarachnoid haemorrhage
338		a print2 rdacarrier
520		a 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.
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
653		a Subarachnoid haemorrhage
653		a Cortisol
653		a ACTH
653		a Diurnal variation
653		a Cerebral oedema
653		a Neurosurgery
653		a Neurokirurgi
653		a Neurosurgery
653		a Neurokirurgi
700	1	a Edén Engström, Brittu Uppsala universitet,Medicin4 aut
700	1	a Hallberg, Lenau Department of Radiology, Karolinska University Hospital, Huddinge4 aut
700	1	a Hillered, Larsu Uppsala universitet,Neurokirurgi4 aut
700	1	a Enblad, Peru Uppsala universitet,Neurokirurgi4 aut
700	1	a Karlsson, Torbjörnu Uppsala universitet,Anestesiologi och intensivvård4 aut
700	1	a Ronne Engström, Elisabethu Uppsala universitet,Neurokirurgi4 aut
710	2	a Uppsala universitetb Neurokirurgi4 org
773	0	t British Journal of Neurosurgeryx 0268-8697x 1360-046X
856	4 8	u https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-128968

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Av författaren/redakt...: Zetterling, Mari ...; Edén Engström, B ...; Hallberg, Lena; Hillered, Lars; Enblad, Per; Karlsson, Torbjö ...; visa fler...; Ronne Engström, ...; visa färre...

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

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Av lärosätet: Uppsala universitet

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