Abstract
Objective
To study the diurnal rhythm of plasma cortisol and corticosteroid binding-globulin (CBG) in brain-injured patients managed in an intensive care unit (ICU).
Design
Observational clinical study.
Setting
Twelve-bed medical/surgical critical care facility.
Patients and participants
Fifteen acute brain-injured (coma-inducing) patients: nine following trauma and six with subarachnoid haemorrhage (SAH).
Interventions
One morning and one evening blood sample were obtained from each patient via an existing arterial line at times which coincided with clinically indicated blood tests.
Measurements and results
The total cortisol measurements in this sample of brain-injured patients is similar to the normal reference range. Only two patients had morning total cortisol measurements greater than the reference range, 140–690 nmol/l, and five patients had evening measurements greater than the 80–330 nmol/l reference range. Eight patients demonstrated diurnal variation of plasma cortisol. Plasma CBG was significantly decreased in all 15 brain-injured patients. All patients had a free cortisol percentage greater than the quoted reference of 5% and five patients had measurements between 12–23%. No diurnal variation in CBG was detected. There was no association between age or mode of injury and cortisol secretion.
Conclusion
Following acute severe brain injury, total serum cortisol is not elevated. This may indicate ‘relative’ hypocortisolaemia in relation to the clinically assessed stress. However, because of the decline in plasma CBG, plasma free cortisol is increased after acute severe brain injury.
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References
Chrousos GP (1995) The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med 332:1351–1362
Wilson JD, Foster DW, Kronenberg HM, Larsen PR (1998) In: Williams Textbook of Endocrinology, 9th edn. Saunders, London, pp 185–159
Beishuizen A, Thijs LG, Vermes I (2001) Pattern of CBG and the free cortisol index during septic shock and multitrauma. Intensive Care Med 27:1584–1591
Woolf PD (1992) Hormonal responses to trauma. Crit Care Med 20:216–226
Estep HL, Litchfield DL, Taylor JP, Tucker HSG Jr (1966) Acute effect of traumatic stress on cortisol metabolism in man. J Clin Endocrinol Metab 26:513–517
Barton RN, Stoner HB, Watson SM (1987) Relationship among plasma cortisol, adrenocorticotrophin and severity of injury in recently injured patients. J Trauma 27:384–392
Cooper MS, Stewart PM (2003) Corticosteroid Insufficiency in acutely ill patients. N Engl J Med 348:727–734
Eledrisi M, Urban RJ, Lieberman SA (2001) Brain injury and neuroendocrine function. Endocrinologist 11:275–281
Koiv L, Merisalu E, Zilmer K, Tomberg T, Kaasik AE (1997) Changes of sympatho-adrenal and hypothalamo-pituitary-adrenocortical system in patients with brain injury. Acta Neurol Scand 96:52–58
Cernak I, Savic VJ, Lazarov A, Joksimovic M, Markovic S (1999) Neuroendocrine responses following graded traumatic brain injury in male adults. Brain Inj 13:1005–1015
Dimopoulou I, Tsagarakis S, Anthi A, Milou E, Ilias I, Stavrakaki K, Charalambidis C, Tzanela M, Orfanos S, Mandragos K, Thalassinos N, Roussos C (2003) High prevalence of decreased cortisol reserve in brain-dead potential organ donors. Crit Care Med 31:1113–1117
Coolens JL, Van Baelen H, Heyns W (1987) Clinical use of unbound plasma cortisol as calculated from total cortisol and corticosteroid-binding globulin. J Steroid Biochem 26:197–202
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Savaridas, T., Andrews, P.J.D. & Harris, B. Cortisol dynamics following acute severe brain injury. Intensive Care Med 30, 1479–1483 (2004). https://doi.org/10.1007/s00134-004-2306-5
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DOI: https://doi.org/10.1007/s00134-004-2306-5