SERUM-CORTISOL LEVELS IN SEVERITY OF STROKE

Abstract

Introduction: Cortisol, an important hormone in the hypothalamic pituitary adrenal axis, has important effects on the metabolism of glucose, protein and lipid[i]. A stress response consists of increased levels of cortisol and catecholamines in the 1st weeks after acute stroke. The cortisol response has been observed in cerebral infarction as well as in intracerebral haemorrhage. Change in serum level of cortisol has been reported in patients with ischemic stroke and studies reported that high levels of this hormone are independently associated with increase in ischemic lesion volume. Also it has been observed that cortisol level in patients with ischemic stroke is associated with significantly increased mortality rate. Increase in the circulating levels of catecholamines was shown in insular damage in experimental stroke suggesting this as a mechanism for the cardiac complications associated with stroke.
 Patients and Methods: All patients were included in the study who was admitted within 6 hours in the hospital after the episode of stroke. Scandinavian Stroke Scale (SSS)[ii] was monitored in all patients from admission. SSS was performed every 2 hours in the first 24 hours, every 4 hours in the next 48 hours and then daily up to day 7. Blood samples were obtained for routine investigation and estimation of serum cortisol. No patients had blood samples drawn for cortisol determination between 01:00 and 07:00 am.
 Results: Mean age was observed in the current series was 72.8 ± 12.54 years. There were 34 (53.1%) male and 30(46.9%) female. SSS was observed to be 36 (21-47) on admission. History of hypertension, History of stroke, Diabetes mellitus and Atrial fibrillation was observed in 38(59.4%), 12(18.8%), 24(37.5%) and 11(17.2%) respectively. In univariate logistic regression analysis of the relations to 7 days of mortality, s-cortisol, SSS on admission, and pulse rate reached a significance level. Age, atrial fibrillation, blood glucose, body temperature 12 h after stroke onset, and the presence of early infarctions signs did not reach a significance level of 0.1 in univariate testing. S-cortisol level was higher in patients with insular involvement, 635 nmol/l, in comparison to patients without insular involvement, 589 nmol/l.
 Conclusion: Adrenal glucocorticoid stress response in acute stroke is harmful. High cortisol levels are associated with the poor outcome and mortality of the patients with stroke.
 Keywords: Cortisol, HPA, Stroke, SSS