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Open Access 01-10-2008 | Research

Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study

Authors: Stepani Bendel, Timo Koivisto, Esko Ruokonen, Jaakko Rinne, Jarkko Romppanen, Ilkka Vauhkonen, Vesa Kiviniemi, Ari Uusaro

Published in: Critical Care | Issue 5/2008

Abstract

Introduction

Subarachnoid haemorrhage (SAH) may damage the hypothalamo-pituitary-adrenal gland (HPA) axis and disturb cortisol metabolism. There are no available data that relates to the response of the HPA axis in the acute phase of SAH. We aimed to characterise the behavior of serum adrenocorticotropic hormone (ACTH), total cortisol, stimulated total cortisol and free cortisol concentrations in acute aneurysmal SAH.

Methods

A prospective cohort study was conducted of patients with acute aneurysmal SAH (n = 30) admitted to a tertiary university hospital. Patients admitted for elective aneurysmal surgery (n = 16) served as the control group. An ACTH stimulation test was performed twice during the first week and at three months. The main outcome measure was description of the ACTH-cortisol response by calculating serum free cortisol and measuring total cortisol and ACTH concentrations. A mixed models method was used for testing between the groups, allowing heterogeneity between the groups.

Results

Patients with SAH had higher initial serum total cortisol (mean +/- SD; 793 +/- 312 nmol/L) and free cortisol concentrations (83 +/- 55 nmol/L) than control patients (535 +/- 193 nmol/L, p = 0.001 and 33 +/- 18 nmol/L, p < 0.001, respectively). Thereafter, there were no differences in this respect. Serum free and total cortisol concentrations correlated but were unaffected by the severity of SAH. ACTH concentrations were comparable between SAH and control groups. Patients with Hunt-Hess grades IV to V had higher ACTH concentrations at day one (10.7 +/- 7.1 pmol/l/L) and day five (8.2 +/- 7.7 pmol/L) than patients with grade I-III (day one: 3.8 +/- 2.0 pmol/L, p = 0.002; day five: 4.7 +/- 1.8 pmol/L, p = 0.04).

Conclusions

Calculation of serum free cortisol concentration was not helpful in identifying patients with potential hypocortisolism. SAH severity did not affect cortisol concentrations, possibly indicating relative pituitary-adrenal insufficiency in patients with more severe bleeding.

Trial registration

ClinicalTrials.gov Identifier NCT00614887.

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Title: Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study
Authors: Stepani Bendel
Timo Koivisto
Esko Ruokonen
Jaakko Rinne
Jarkko Romppanen
Ilkka Vauhkonen
Vesa Kiviniemi
Ari Uusaro
Publication date: 01-10-2008
Publisher: BioMed Central
Published in: Critical Care / Issue 5/2008
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/cc7084

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Trial registration

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