Cortisol dynamics have been found to be disturbed in acute illness. Despite reports on neuroendocrine disturbances after aneurysmal subarachnoid hemorrhage (SAH), data on cortisol dynamics in the acute phase of this illness are lacking. We evaluated diurnal cortisol rhythm in n=25 patients 1 week (t1) and 23 weeks (t2) after SAH. The study was approved by the local ethics committee. Cortisol and CBG were measured in serum, blood samples were drawn at 08:00, 12:00, 16:00 and 20:00. Clinical parameters pertaining to the severity of SAH and clinical outcome were set in relation to the cortisol measurements.
One week after SAH only 5/25 patients had normal diurnal variation of serum cortisol. 9/25 had no variation at all, 1/25 showed an inversed slope with low morning and high evening cortisol values. In 10/25 no clear pattern was detected.
Two weeks later, three of the initial 5 patients still had normal cortisol rhythms, the remaining two changed to an undetectable rhythm. 4 Patients with formerly flat rhythms and one patient without a pattern at t1 had a normal variation at t2. In sum, 8/25 patients had a normal circadian variation 23 weeks after SAH. The other patients provided no pattern (13/25) or a reversed slope (4/25). When comparing patients with normal slopes with those with no or an altered diurnal profile at t1, those with a normal profile had a significantly less severe hemorrhage (Fisher-CT-Score; ManWhitney U-test, P=0.042) and a shorter hospital stay (P=0.052). The same comparison at t2 showed that patients with normal slopes gained a better outcome measured by the Glasgow Outcome Scale 312 months after SAH (P=0.039).
First analyses suggest that a normal diurnal cortisol profile in the acute phase of SAH may be associated with a less severe bleeding and may be a predictor of a better long-term outcome.
03 - 07 May 2008
European Society of Endocrinology