Anterior pituitary axis hormones and outcome in acute ischaemic stroke

Abstract

. Neidert S, Katan M, Schuetz P, Fluri F, Ernst A, Bingisser R, Kappos L, Engelter ST, Steck A, Müller B, Christ‐Crain M (University Hospital Basel, Basel, Switzerland; SphingoTec GmbH, Borgsorf, Germany; Kantonsspital Aarau, Aarau, Switzerland) Anterior pituitary axis hormones and outcome in acute ischaemic stroke. J Intern Med 2011; 269: 420–432. Background. Early and accurate prediction of outcome in acute stroke is important and influences risk‐optimized therapeutic strategies. Endocrine alterations of the hypothalamic–pituitary axis are amongst the first measurable alterations after cerebral ischaemia. We therefore evaluated the prognostic value of cortisol, triiodothyronine (T3), free thyroxine (fT4), thyroid‐stimulating hormone (TSH) and growth hormone (GH) in patients with an acute ischaemic stroke. Methods. In an observational study including 281 patients with ischaemic stroke, anterior pituitary axis hormones (i.e. cortisol, T3, fT4, TSH and GH) were simultaneously assessed to determine their value to predict functional outcome and mortality within 90 days and 1 year. Results. In receiver operating characteristic curve analysis, the prognostic accuracy of cortisol was higher compared to all measured hormones and was in the range of the National Institutes of Health Stroke Scale (NIHSS). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio (OR) 1.0 (1.0–1.01) and 1.62 (1.37–1.92), respectively, P < 0.0002 for both, adjusted for age and the NIHSS] in patients with ischaemic stroke, but added no significant additional predictive value to the clinical NIHSS score. Conclusion. Cortisol is an independent prognostic marker for death and functional outcome within 90 days and 1 year in patients with ischaemic stroke. By contrast, other anterior pituitary axis hormones such as peripheral thyroid hormones and GH are only of minor value to predict outcome in stroke.

Prognostic Value of Cortisol in Patients with Acute Ischemic Stroke

“…Ziet al, in a cohort study, observed that cortisol level is related to 90-day mortality rate [5] Markund et al, in a study on 88 patients with cerebral infarctions, observed that high level of cortisol is related to delirium and mortality [7]. Similar studies in Switzerland, America and Denmark also confirmed above findings [6,8,20]. Some researches show that cortisol level change is seen only in stroke, but not in TIA [21].…”

“…Change in serum level of this hormone have been reported in patients with ischemic stroke and some studies suggested high levels of this hormone is independently associated with increase in ischemic lesion volume [5]. Also, some studies indicated that cortisol level in patients with ischemic stroke is associated with significantly increased mortality rate [4,6,7]. Some studies reported a Correlation between cortisol level and post stroke physical and psychological disability [8][9][10][11].…”

Prognostic Value of Hypothalamic Copeptin in Acute Ischemic Stroke

“…These included CRP [7][8][9], IL-6 [2], matrix metalloproteinase-9 [10], fibrinogen [11], brain atriuretic peptide [12], and cortisol [13]. How- Cryptogenic (IV) 12.0 ± 6.0 Hypothalamic…”

The Link between Early Biomarker Analysis and the Neurological Outcome in Stroke Patients

“…All three included studies measured the outcome at three months [32,44,45]. Low cortisol levels are possibly linked to a good outcome at three months.…”