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Cortisol dynamics following acute severe brain injury
To study the diurnal rhythm of plasma cortisol and corticosteroid binding-globulin (CBG) in brain-injured patients managed in an intensive care unit (ICU). Observational clinical study. Twelve-bed medical/surgical critical care facility. Fifteen acute brain-injured (coma-inducing) patients: nine fol...
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| Published in: | Intensive care medicine 2004-07, Vol.30 (7), p.1479-1483 |
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| container_title | Intensive care medicine |
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| creator | SAVARIDAS, Terence ANDREWS, Peter J. D HARRIS, Bridget |
| description | To study the diurnal rhythm of plasma cortisol and corticosteroid binding-globulin (CBG) in brain-injured patients managed in an intensive care unit (ICU).
Observational clinical study.
Twelve-bed medical/surgical critical care facility.
Fifteen acute brain-injured (coma-inducing) patients: nine following trauma and six with subarachnoid haemorrhage (SAH).
One morning and one evening blood sample were obtained from each patient via an existing arterial line at times which coincided with clinically indicated blood tests.
The total cortisol measurements in this sample of brain-injured patients is similar to the normal reference range. Only two patients had morning total cortisol measurements greater than the reference range, 140-690 nmol/l, and five patients had evening measurements greater than the 80-330 nmol/l reference range. Eight patients demonstrated diurnal variation of plasma cortisol. Plasma CBG was significantly decreased in all 15 brain-injured patients. All patients had a free cortisol percentage greater than the quoted reference of 5% and five patients had measurements between 12-23%. No diurnal variation in CBG was detected. There was no association between age or mode of injury and cortisol secretion.
Following acute severe brain injury, total serum cortisol is not elevated. This may indicate 'relative' hypocortisolaemia in relation to the clinically assessed stress. However, because of the decline in plasma CBG, plasma free cortisol is increased after acute severe brain injury. |
| doi_str_mv | 10.1007/s00134-004-2306-5 |
| format | article |
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Observational clinical study.
Twelve-bed medical/surgical critical care facility.
Fifteen acute brain-injured (coma-inducing) patients: nine following trauma and six with subarachnoid haemorrhage (SAH).
One morning and one evening blood sample were obtained from each patient via an existing arterial line at times which coincided with clinically indicated blood tests.
The total cortisol measurements in this sample of brain-injured patients is similar to the normal reference range. Only two patients had morning total cortisol measurements greater than the reference range, 140-690 nmol/l, and five patients had evening measurements greater than the 80-330 nmol/l reference range. Eight patients demonstrated diurnal variation of plasma cortisol. Plasma CBG was significantly decreased in all 15 brain-injured patients. All patients had a free cortisol percentage greater than the quoted reference of 5% and five patients had measurements between 12-23%. No diurnal variation in CBG was detected. There was no association between age or mode of injury and cortisol secretion.
Following acute severe brain injury, total serum cortisol is not elevated. This may indicate 'relative' hypocortisolaemia in relation to the clinically assessed stress. However, because of the decline in plasma CBG, plasma free cortisol is increased after acute severe brain injury.</description><identifier>ISSN: 0342-4642</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-004-2306-5</identifier><identifier>PMID: 15138673</identifier><identifier>CODEN: ICMED9</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Adolescent ; Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Arterial lines ; Biological and medical sciences ; Blood Pressure - physiology ; Blood tests ; Brain Injuries - blood ; Brain Injuries - etiology ; Brain Injuries - physiopathology ; Circadian Rhythm - physiology ; Cytokines ; Electrocardiography ; Female ; Hormones ; Humans ; Hydrocortisone - blood ; Intensive care ; Intensive care medicine ; Intensive Care Units ; Male ; Medical sciences ; Middle Aged ; Plasma ; Subarachnoid Hemorrhage - blood ; Subarachnoid Hemorrhage - complications ; Time Factors ; Transcortin - analysis ; Trauma ; Traumatic brain injury ; Wounds and Injuries - blood ; Wounds and Injuries - complications</subject><ispartof>Intensive care medicine, 2004-07, Vol.30 (7), p.1479-1483</ispartof><rights>2004 INIST-CNRS</rights><rights>Copyright Springer-Verlag 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c354t-2516d280cec3e382ccd690d9c347b6ad7a1ec313032c1fad0fc2c292df4de2753</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15915756$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15138673$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SAVARIDAS, Terence</creatorcontrib><creatorcontrib>ANDREWS, Peter J. D</creatorcontrib><creatorcontrib>HARRIS, Bridget</creatorcontrib><title>Cortisol dynamics following acute severe brain injury</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><description>To study the diurnal rhythm of plasma cortisol and corticosteroid binding-globulin (CBG) in brain-injured patients managed in an intensive care unit (ICU).
Observational clinical study.
Twelve-bed medical/surgical critical care facility.
Fifteen acute brain-injured (coma-inducing) patients: nine following trauma and six with subarachnoid haemorrhage (SAH).
One morning and one evening blood sample were obtained from each patient via an existing arterial line at times which coincided with clinically indicated blood tests.
The total cortisol measurements in this sample of brain-injured patients is similar to the normal reference range. Only two patients had morning total cortisol measurements greater than the reference range, 140-690 nmol/l, and five patients had evening measurements greater than the 80-330 nmol/l reference range. Eight patients demonstrated diurnal variation of plasma cortisol. Plasma CBG was significantly decreased in all 15 brain-injured patients. All patients had a free cortisol percentage greater than the quoted reference of 5% and five patients had measurements between 12-23%. No diurnal variation in CBG was detected. There was no association between age or mode of injury and cortisol secretion.
Following acute severe brain injury, total serum cortisol is not elevated. This may indicate 'relative' hypocortisolaemia in relation to the clinically assessed stress. However, because of the decline in plasma CBG, plasma free cortisol is increased after acute severe brain injury.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Arterial lines</subject><subject>Biological and medical sciences</subject><subject>Blood Pressure - physiology</subject><subject>Blood tests</subject><subject>Brain Injuries - blood</subject><subject>Brain Injuries - etiology</subject><subject>Brain Injuries - physiopathology</subject><subject>Circadian Rhythm - physiology</subject><subject>Cytokines</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Hormones</subject><subject>Humans</subject><subject>Hydrocortisone - blood</subject><subject>Intensive care</subject><subject>Intensive care medicine</subject><subject>Intensive Care Units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Plasma</subject><subject>Subarachnoid Hemorrhage - blood</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Time Factors</subject><subject>Transcortin - analysis</subject><subject>Trauma</subject><subject>Traumatic brain injury</subject><subject>Wounds and Injuries - blood</subject><subject>Wounds and Injuries - complications</subject><issn>0342-4642</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><recordid>eNpd0MtKxDAUgOEgijOOPoAbKYLuoifXtksZvMGAG12HTJJKhrbRpFXm7c0wBcVVFvnO4fAjdE7ghgCUtwmAMI4BOKYMJBYHaE44o5hQVh2iOTBOMZecztBJSpusSynIMZoRQVglSzZHYhni4FNoC7vtdedNKprQtuHb9--FNuPgiuS-XHTFOmrfF77fjHF7io4a3SZ3Nr0L9PZw_7p8wquXx-fl3QobJviAqSDS0gqMM8yxihpjZQ22NoyXa6ltqUn-IQwYNaTRFhpDDa2pbbh1tBRsga73ez9i-BxdGlTnk3Ftq3sXxqSklKIGyjK8_Ac3YYx9vk1RIinUOUtGZI9MDClF16iP6Dsdt4qA2gVV-6AqB1W7oGp3wcW0eFx3zv5OTAUzuJqATka3TdS98emPq4kohWQ_6lJ8sA</recordid><startdate>20040701</startdate><enddate>20040701</enddate><creator>SAVARIDAS, Terence</creator><creator>ANDREWS, Peter J. 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D ; HARRIS, Bridget</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c354t-2516d280cec3e382ccd690d9c347b6ad7a1ec313032c1fad0fc2c292df4de2753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Arterial lines</topic><topic>Biological and medical sciences</topic><topic>Blood Pressure - physiology</topic><topic>Blood tests</topic><topic>Brain Injuries - blood</topic><topic>Brain Injuries - etiology</topic><topic>Brain Injuries - physiopathology</topic><topic>Circadian Rhythm - physiology</topic><topic>Cytokines</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Hormones</topic><topic>Humans</topic><topic>Hydrocortisone - blood</topic><topic>Intensive care</topic><topic>Intensive care medicine</topic><topic>Intensive Care Units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Plasma</topic><topic>Subarachnoid Hemorrhage - blood</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Time Factors</topic><topic>Transcortin - analysis</topic><topic>Trauma</topic><topic>Traumatic brain injury</topic><topic>Wounds and Injuries - blood</topic><topic>Wounds and Injuries - complications</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SAVARIDAS, Terence</creatorcontrib><creatorcontrib>ANDREWS, Peter J. D</creatorcontrib><creatorcontrib>HARRIS, Bridget</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SAVARIDAS, Terence</au><au>ANDREWS, Peter J. D</au><au>HARRIS, Bridget</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cortisol dynamics following acute severe brain injury</atitle><jtitle>Intensive care medicine</jtitle><addtitle>Intensive Care Med</addtitle><date>2004-07-01</date><risdate>2004</risdate><volume>30</volume><issue>7</issue><spage>1479</spage><epage>1483</epage><pages>1479-1483</pages><issn>0342-4642</issn><eissn>1432-1238</eissn><coden>ICMED9</coden><abstract>To study the diurnal rhythm of plasma cortisol and corticosteroid binding-globulin (CBG) in brain-injured patients managed in an intensive care unit (ICU).
Observational clinical study.
Twelve-bed medical/surgical critical care facility.
Fifteen acute brain-injured (coma-inducing) patients: nine following trauma and six with subarachnoid haemorrhage (SAH).
One morning and one evening blood sample were obtained from each patient via an existing arterial line at times which coincided with clinically indicated blood tests.
The total cortisol measurements in this sample of brain-injured patients is similar to the normal reference range. Only two patients had morning total cortisol measurements greater than the reference range, 140-690 nmol/l, and five patients had evening measurements greater than the 80-330 nmol/l reference range. Eight patients demonstrated diurnal variation of plasma cortisol. Plasma CBG was significantly decreased in all 15 brain-injured patients. All patients had a free cortisol percentage greater than the quoted reference of 5% and five patients had measurements between 12-23%. No diurnal variation in CBG was detected. There was no association between age or mode of injury and cortisol secretion.
Following acute severe brain injury, total serum cortisol is not elevated. This may indicate 'relative' hypocortisolaemia in relation to the clinically assessed stress. However, because of the decline in plasma CBG, plasma free cortisol is increased after acute severe brain injury.</abstract><cop>Heidelberg</cop><cop>Berlin</cop><pub>Springer</pub><pmid>15138673</pmid><doi>10.1007/s00134-004-2306-5</doi><tpages>5</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Arterial lines Biological and medical sciences Blood Pressure - physiology Blood tests Brain Injuries - blood Brain Injuries - etiology Brain Injuries - physiopathology Circadian Rhythm - physiology Cytokines Electrocardiography Female Hormones Humans Hydrocortisone - blood Intensive care Intensive care medicine Intensive Care Units Male Medical sciences Middle Aged Plasma Subarachnoid Hemorrhage - blood Subarachnoid Hemorrhage - complications Time Factors Transcortin - analysis Trauma Traumatic brain injury Wounds and Injuries - blood Wounds and Injuries - complications |
| title | Cortisol dynamics following acute severe brain injury |
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