title: Anterior pituitary axis hormones and outcome in acute ischaemic stroke.
abstract: BACKGROUND
  Early and accurate prediction of outcome in acute stroke is important and influences risk-optimized therapeutic strategies. Endocrine alterations of the hypothalamic-pituitary axis are amongst the first measurable alterations after cerebral ischaemia. We therefore evaluated the prognostic value of cortisol, triiodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH) and growth hormone (GH) in patients with an acute ischaemic stroke.
  
  
  METHODS
  In an observational study including 281 patients with ischaemic stroke, anterior pituitary axis hormones (i.e. cortisol, T3, fT4, TSH and GH) were simultaneously assessed to determine their value to predict functional outcome and mortality within 90 days and 1 year.
  
  
  RESULTS
  In receiver operating characteristic curve analysis, the prognostic accuracy of cortisol was higher compared to all measured hormones and was in the range of the National Institutes of Health Stroke Scale (NIHSS). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio (OR) 1.0 (1.0-1.01) and 1.62 (1.37-1.92), respectively, P<0.0002 for both, adjusted for age and the NIHSS] in patients with ischaemic stroke, but added no significant additional predictive value to the clinical NIHSS score.
  
  
  CONCLUSIONS
  Cortisol is an independent prognostic marker for death and functional outcome within 90 days and 1 year in patients with ischaemic stroke. By contrast, other anterior pituitary axis hormones such as peripheral thyroid hormones and GH are only of minor value to predict outcome in stroke.
authors.affiliation: Department of Endocrinology, University Hospital Basel, Basel, Switzerland. neiderts@uhbs.ch
authors.forename: S
authors.initials: S
authors.lastname: Neidert
authors.forename: M
authors.initials: M
authors.lastname: Katan
authors.forename: P
authors.initials: P
authors.lastname: Schuetz
authors.forename: F
authors.initials: F
authors.lastname: Fluri
authors.forename: A
authors.initials: A
authors.lastname: Ernst
authors.forename: R
authors.initials: R
authors.lastname: Bingisser
authors.forename: L
authors.initials: L
authors.lastname: Kappos
authors.forename: S T
authors.initials: ST
authors.lastname: Engelter
authors.forename: A
authors.initials: A
authors.lastname: Steck
authors.forename: B
authors.initials: B
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Christ-Crain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood* / Q000150:complications; D004812:Epidemiologic Methods; D005260:Female; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D010908:Pituitary Hormones, Anterior / Q000097:blood*; D011379:Prognosis; D020521:Stroke / Q000097:blood* / Q000209:etiology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood
chemical_list: D015415:Biomarkers; D010908:Pituitary Hormones, Anterior; D014284:Triiodothyronine; D019382:Human Growth Hormone; D013972:Thyrotropin; D013974:Thyroxine; D006854:Hydrocortisone