Circadian rhythm of the plasma cortisol level in cases of prolonged coma.

Abstract

Circadian variations of plasma cortisol were studied in four different groups of subjects; 17 patients with prolonged coma, 3 patient with tetraplegia with alert consciousness and without body movement, 4 patients with stabilized chronic infection with alert consciousness and with normal body movement, and control subjects consisting of 7 healthy volunteers and 5 patients with various neuromuscular disease without disturbance of con sciousness, motor dysfunction or infection. The maximum level of plasma cortisol attained during the circadian variations was low in prolonged coma, whereas the minimum level was high in prolonged coma, as compared to other three groups. The amplitudes between the maximum and the minimum level were significantly smaller in prolonged coma than in control (p<0.005). The tendency that the maximum level appeared at early morning and the minimum at late evening was similarly observed in both prolonged coma and control groups suggesting that there is no phase shift of the circadian rhythm of cortisol in prolonged coma. The responses of plasma TSH to synthetic TSH-releasing hormone or those of plasma cortisol to ACTH were not different between prolonged coma and control, suggesting that the reduced amplitude in prolonged coma is not attributed to the function of the patients' pituitary and/or adrenal cortex. Also, there were no differences in diurnal variations in plasma glucose or non-esterified fatty acid between the prolonged coma and control, nevertheless the former was fed with liquid food via a i asal tube. Therefore, highly significant reduction of the amplitude of circadian variation of cortisol in prolonged coma may not be due to exogenous factors, such as a poverty of body movement, complications due to chronic infec tion, or tube feeding. The results seem to suggest that the reduced amplitude of the circadian variations in plasma cortisol may have relation to the unconsciousness of prolonged coma due to severe damage to the central nervous system.

Circadian rhythm studies in neuronal ceroid‐lipofuscinosis (NCL)

“…The cortisol amplitudes were lower in both JNCL and INCL patients than in the control subjects. This is in agreement with previous reports about brain damaged patients [Okuyama et al, 1977;Braunsdorf et al, 19861.…”

Twenty‐four‐hour Profiles of Growth Hormone, Prolactin and Cortisol in the Chronic Vegetative State

“…We investigated the spontaneous growth hormone (GH), prolactin (PRL) and cortisol secretion in the chronic vegetative state in comparison with an age and sex-matched control group, although information on this topic is already available (Nocke-Finck et al, 1978;Okuyama et al, 1977;Ratge et af., 1982;Sack et al, 1983). It was our main interest to study short-term pulsatility with an adequate algorithm and to look for potential associations between electroencephalographic patterns and hormonal parameters.…”

Suppression of Plasma Prolactin in a Patient with a Pinealocytoma

“…The preoperative absence of plasma PRL could not be explained by any of the factors known to cause alteration in its secretion: the day-night schedule was not altered, physical or psychic stress was absent, and lesions of the hypothalamic region (Okuyama, Endo and Ohara 1977) could be excluded. There was also no evidence of dopamine hypersecretion, since pre-and post-operative HGH-secretion was not stimulated (Martin 1978 …”