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Cortisol and adrenocorticotropic hormone dynamics in the acute phase of subarachnoid haemorrhage
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
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2011 (English)In: British Journal of Neurosurgery, ISSN 0268-8697, E-ISSN 1360-046X, Vol. 25, no 6, 684-692 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
2011. Vol. 25, no 6, 684-692 p.
Keyword [en]
Subarachnoid haemorrhage, cortisol, ACTH, diurnal variation, cerebral oedema
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-165676DOI: 10.3109/02688697.2011.584638ISI: 000297337800006OAI: oai:DiVA.org:uu-165676DiVA: diva2:475006
Available from: 2012-01-10 Created: 2012-01-09 Last updated: 2017-12-08Bibliographically approved

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Zetterling, MariaEdén Engström, BrittHillered, LarsEnblad, PerKarlsson, TorbjörnRonne-Engström, Elisabeth

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Zetterling, MariaEdén Engström, BrittHillered, LarsEnblad, PerKarlsson, TorbjörnRonne-Engström, Elisabeth
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NeurosurgeryDepartment of Medical SciencesAnaesthesiology and Intensive Care
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