title: A new way of thinking: hydrocortisone in traumatic brain-injured patients.
abstract: Data suggest that treatment of critical illness-related corticosteroid insufficiency after traumatic brain injury (TBI) with a stress dose of hydrocortisone may improve the neurological outcome and the mortality rate. The mineralocorticoid properties of hydrocortisone may reduce the rate of hyponatremia and of brain swelling. The exaggerated inflammatory response may cause critical illness-related corticosteroid insufficiency by altering the function of the hypothalamic-pituitary-adrenal axis, and hydrocortisone is able to restore a balanced inflammatory response rather than inducing immunosuppression. Hydrocortisone could also prevent neuronal apoptosis. Considering side effects, corticosteroids are not equal; when a high dose of synthetic corticosteroids seems detrimental, a strategy using a stress dose of hydrocortisone seems attractive. Finally, results from a large multicenter study are needed to close the debate regarding the use of hydrocortisone in TBI patients.
authors: Antoine
authors: A
authors: Roquilly
authors: Mickael
authors: M
authors: Vourc'h
authors: Raphael
authors: R
authors: Cinotti
authors: Karim
authors: K
authors: Asehnoune
mesh_terms: D000305:Adrenal Cortex Hormones / Q000172:deficiency* / Q000494:pharmacology*; D000818:Animals; D001930:Brain Injuries / Q000188:drug therapy*; D016638:Critical Illness; D006854:Hydrocortisone / Q000494:pharmacology*; D008297:Male; D008775:Methylprednisolone / Q000494:pharmacology*
chemical_list: D000305:Adrenal Cortex Hormones; D006854:Hydrocortisone; D008775:Methylprednisolone