title: Cortisol dynamics in the acute phase of aneurysmal subarachnoid hemorrhage: associations with disease severity and outcome.
abstract: The purpose of this study was to assess cortisol dynamics in the acute phase after aneurysmal subarachnoid hemorrhage (SAH) and to set the parameters of cortisol release in relation to the severity of illness and outcome. In 22 consecutive patients with aneurysmal SAH, cortisol, corticosteroid binding globulin, interleukin-6, and adrenocorticotrophic hormone were measured immediately after hospital admission (t(0)), 7 days (t(1)) later, and at least 14 days later (t(2)). Additionally, diurnal profiles of cortisol secretion were assessed at t(1) and t(2), and area under the curve (AUC) was computed for calculated free serum cortisol (CFSC). In this study, normal diurnal CFSC profiles were associated with a significantly shorter ICU-stay, less complications, and a more favorable outcome than abnormal diurnal profiles. AUC and 8 a.m. cortisol were not related to clinical course or outcome. It is concluded that cortisol secretion patterns are associated with the severity and outcome of SAH. For an appraisal of the hypothalamo-pituitary-adrenal axis in SAH patients, single cortisol measurements are insufficient.
authors.affiliation: Department of Neurosurgery, University Hospital, RWTH Aachen, Aachen, Germany. epoll@ukaachen.de
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Poll
authors.forename: Azize
authors.initials: A
authors.lastname: Boström
authors.forename: Uli
authors.initials: U
authors.lastname: Bürgel
authors.forename: Marcus H
authors.initials: MH
authors.lastname: Reinges
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Hans
authors.forename: Joachim M
authors.initials: JM
authors.lastname: Gilsbach
authors.forename: Ilonka
authors.initials: I
authors.lastname: Kreitschmann-Andermahr
mesh_terms: D000208:Acute Disease; D000324:Adrenocorticotropic Hormone / Q000097:blood; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D002940:Circadian Rhythm / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism*; D007030:Hypothalamo-Hypophyseal System / Q000378:metabolism* / Q000503:physiopathology; D007362:Intensive Care Units; D015850:Interleukin-6 / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013312:Stress, Physiological / Q000502:physiology*; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000503:physiopathology; D014156:Transcortin / Q000378:metabolism
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D000324:Adrenocorticotropic Hormone; D014156:Transcortin; D006854:Hydrocortisone