title: Cortisol and adrenocorticotropic hormone dynamics in the acute  phase of subarachnoid haemorrhage.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, Sweden. maria.zetterling@telia.com
authors: Maria
authors: M
authors: Zetterling
authors: Britt Edén
authors: BE
authors: Engström
authors: Lena
authors: L
authors: Hallberg
authors: Lars
authors: L
authors: Hillered
authors: Per
authors: P
authors: Enblad
authors: Torbjörn
authors: T
authors: Karlsson
authors: Elisabeth
authors: E
authors: Ronne Engström
mesh_terms: D000208:Acute Disease; D000324:Adrenocorticotropic Hormone / Q000097:blood*; D001929:Brain Edema / Q000097:blood / Q000209:etiology; D002545:Brain Ischemia / Q000097:blood / Q000209:etiology; D002940:Circadian Rhythm / Q000502:physiology; D003422:Critical Care; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000652:urine; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000502:physiology*; D012016:Reference Values; D012121:Respiration, Artificial; D018709:Statistics, Nonparametric; D013345:Subarachnoid Hemorrhage / Q000097:blood* / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
chemical_list: D000324:Adrenocorticotropic Hormone; D006854:Hydrocortisone