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.

Clinical prevalence and outcome impact of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review with meta-analysis

“…The majority of them were prospective single-centre studies (N = 15, 75 %), two were prospective multi-centric Criteria for diagnosis of endocrine abnormality differed widely, and included both basal hormone levels and stimulation tests ( Table 2). Five authors studied just a single hormonal axis (somatotropic [10], or adrenal axis [13,[26][27][28]) and the remaining studied multiple hormone alterations.…”

“…Similar results were described by Pereira et al [15] who demonstrated that hormone deficiency is not significantly associated (p = 0.05) with increased hospitalization or clinical outcome. In opposition, some authors found a significant association between pituitary dysfunction and patients' outcome [11,13]: Lammert et al [24] demonstrated that all patients with neuro-endocrine dysfunction presented impaired clinical outcome (p value = 0.007) and Poll et al [28] found that patients with normal diurnal free serum cortisol had a significantly shorter ICUstay, less complications, and a more favorable outcome (p value = 0.051).…”

Endocrine Function Following Acute SAH

“…The degree of cortisol elevation was not associated with the severity of SAH. In contrast, mixed results of normal cortisol with low or normal levels of ACTH were found by Poll et al [16]. In the latter study, the diurnal variation of free cortisol levels was abnormal in some SAH patients, and correlated with poor outcome and longer length of stay compared with those patients with normal diurnal variation.…”

“…Several prospective observational studies have been performed to document the incidence of dysfunction of the HPA axes, primarily through prospective measures of individual hormonal concentrations in the acute and chronic setting (Table 1 [4,[7][8][9][10][11][12][13][14][15][16]). Unfortunately, most studies focus on the chronic setting from 12 to 72 months after SAH.…”

SAH Pituitary Adrenal Dysfunction

“…Several prospective observational studies have been performed to document the incidence of dysfunction of the HPA axis, primarily through prospective measures of individual hormonal concentrations in the acute and chronic setting (Table 1; [4,[7][8][9][10][11][12][13][14][15][16]). Unfortunately, most studies focus on the chronic setting from 12 to 72 months after SAH.…”