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Abnormalities at different levels of the hypothalamic-pituitary-adrenocortical axis early after stroke

Olsson, T; Marklund, N LU ; Gustafson, Y and Näsman, B (1992) In Stroke 23(11). p.6-1573
Abstract

BACKGROUND AND PURPOSE: Hypercortisolism is common in stroke patients. The aim of this study was to investigate possible disturbances at different sites within the hypothalamic-pituitary-adrenal axis. We also studied possible associations between hypercortisolism and clinical manifestations of brain dysfunction.

METHODS: Patients with an acute ischemic stroke (n = 16; mean +/- SD age, 71 +/- 11 years) were compared with healthy elderly subjects (n = 9). We performed a short adrenocorticotropic hormone (ACTH) test with 0.25 mg 1-24 ACTH injected intravenously and an overnight dexamethasone suppression test with 1 mg dexamethasone given orally at 11 PM.

RESULTS: Serum cortisol levels after dexamethasone at 8 AM were... (More)

BACKGROUND AND PURPOSE: Hypercortisolism is common in stroke patients. The aim of this study was to investigate possible disturbances at different sites within the hypothalamic-pituitary-adrenal axis. We also studied possible associations between hypercortisolism and clinical manifestations of brain dysfunction.

METHODS: Patients with an acute ischemic stroke (n = 16; mean +/- SD age, 71 +/- 11 years) were compared with healthy elderly subjects (n = 9). We performed a short adrenocorticotropic hormone (ACTH) test with 0.25 mg 1-24 ACTH injected intravenously and an overnight dexamethasone suppression test with 1 mg dexamethasone given orally at 11 PM.

RESULTS: Serum cortisol levels after dexamethasone at 8 AM were significantly higher in stroke patients (p = 0.003). The area under the curve for the cortisol response to ACTH was elevated in seven (47%) of stroke patients, and the centered cumulative cortisol response was elevated in three (20%) patients. The area under the curve response correlated significantly to the presence of an acute confusional state and male sex in stroke patients (rs = 0.63 and rs = 0.62, respectively; p < 0.05), whereas the centered cumulative cortisol response diminished with increasing age (rs = -0.62; p < 0.05). Postdexamethasone cortisol levels were significantly correlated to the presence of an acute confusional state and to extensive limb paresis (rs = 0.66 and rs = 0.62, respectively; p < 0.05).

CONCLUSIONS: There are abnormalities in the cortisol axis both at the central level and at the adrenal level early after stroke. Hypercortisolism is closely associated with cognitive disturbances and extensive motor impairment.

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publication status
published
keywords
Adrenal Cortex, Adrenocorticotropic Hormone, Aged, Aged, 80 and over, Cerebrovascular Disorders, Confusion, Extremities, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Male, Middle Aged, Paralysis, Pituitary-Adrenal System, Journal Article, Research Support, Non-U.S. Gov't
in
Stroke
volume
23
issue
11
pages
4 pages
publisher
American Heart Association
external identifiers
  • scopus:0026441241
ISSN
0039-2499
language
English
LU publication?
no
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587c84e0-31db-40db-9515-28a4d9542f59
date added to LUP
2018-03-01 09:54:26
date last changed
2018-03-04 05:09:04
@article{587c84e0-31db-40db-9515-28a4d9542f59,
  abstract     = {<p>BACKGROUND AND PURPOSE: Hypercortisolism is common in stroke patients. The aim of this study was to investigate possible disturbances at different sites within the hypothalamic-pituitary-adrenal axis. We also studied possible associations between hypercortisolism and clinical manifestations of brain dysfunction.</p><p>METHODS: Patients with an acute ischemic stroke (n = 16; mean +/- SD age, 71 +/- 11 years) were compared with healthy elderly subjects (n = 9). We performed a short adrenocorticotropic hormone (ACTH) test with 0.25 mg 1-24 ACTH injected intravenously and an overnight dexamethasone suppression test with 1 mg dexamethasone given orally at 11 PM.</p><p>RESULTS: Serum cortisol levels after dexamethasone at 8 AM were significantly higher in stroke patients (p = 0.003). The area under the curve for the cortisol response to ACTH was elevated in seven (47%) of stroke patients, and the centered cumulative cortisol response was elevated in three (20%) patients. The area under the curve response correlated significantly to the presence of an acute confusional state and male sex in stroke patients (rs = 0.63 and rs = 0.62, respectively; p &lt; 0.05), whereas the centered cumulative cortisol response diminished with increasing age (rs = -0.62; p &lt; 0.05). Postdexamethasone cortisol levels were significantly correlated to the presence of an acute confusional state and to extensive limb paresis (rs = 0.66 and rs = 0.62, respectively; p &lt; 0.05).</p><p>CONCLUSIONS: There are abnormalities in the cortisol axis both at the central level and at the adrenal level early after stroke. Hypercortisolism is closely associated with cognitive disturbances and extensive motor impairment.</p>},
  author       = {Olsson, T and Marklund, N and Gustafson, Y and Näsman, B},
  issn         = {0039-2499},
  keyword      = {Adrenal Cortex,Adrenocorticotropic Hormone,Aged,Aged, 80 and over,Cerebrovascular Disorders,Confusion,Extremities,Female,Humans,Hydrocortisone,Hypothalamo-Hypophyseal System,Male,Middle Aged,Paralysis,Pituitary-Adrenal System,Journal Article,Research Support, Non-U.S. Gov't},
  language     = {eng},
  number       = {11},
  pages        = {6--1573},
  publisher    = {American Heart Association},
  series       = {Stroke},
  title        = {Abnormalities at different levels of the hypothalamic-pituitary-adrenocortical axis early after stroke},
  volume       = {23},
  year         = {1992},
}