The low-dose corticotropin stimulation test in acute traumatic and non-traumatic brain injury: incidence of hypo-responsiveness and relationship to outcome

• Published in: Intensive care medicine 2004-06, Vol.30 (6), p.1216-1219
• Main Authors: DIMOPOULOU, Ioanna, TSAGARAKIS, Stylianos, DOUKA, Evangelia, ZERVOU, Maria, KOUYIALIS, Andreas T, DAFNI, Urania, THALASSINOS, Nikolaos, ROUSSOS, Charis
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Function Tests; Adrenal Insufficiency - diagnosis; Adrenal Insufficiency - epidemiology; Adrenocorticotropic Hormone; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brain Injuries - diagnosis; Brain Injuries - mortality; Female; Greece - epidemiology; Hemorrhage; Hormones; Humans; Hydrocortisone - blood; Illnesses; Incidence; Intensive care; Intensive care medicine; Intracranial Hemorrhages - diagnosis; Intracranial Hemorrhages - mortality; Investigations; Logistic Models; Male; Medical prognosis; Medical sciences; Middle Aged; Mortality; Predictive Value of Tests; Prognosis; Prospective Studies; Regression analysis; Stroke - diagnosis; Stroke - mortality; Trauma; Traumatic brain injury
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-004-2297-2

To investigate adrenal responses to the low-dose corticotropin (ACTH) stimulation test in acute traumatic or non-traumatic brain injury (BI) and to assess its value in predicting outcome. Prospective study. SETTING. Intensive care unit (ICU) in a university hospital. Seventy-five patients with acute BI, with a median age of 45 years were investigated. BI was due to trauma ( n=51), ischemic stroke ( n=17), subarachnoid hemorrhage ( n=4) or intracerebral hemorrhage (n=3). Blood was taken on day 16 (median) after admission to the ICU to determine baseline cortisol and ACTH. Thereafter, a low-dose stimulation test (LDST) was performed: 1 microg of tetracosactrin was injected and 30 min later a second blood specimen was obtained to measure stimulated cortisol. Patients having a stimulated cortisol below 500 nmol/l were defined as non-responders to the LDST. Median baseline and stimulated cortisol were 491 nmol/l and 690 nmol/l, respectively. The median increment in cortisol was 154 nmol/l (range 5-579 nmol/l). Mean ACTH was 46+/-21 pg/ml. Ten (13%) patients were non-responders to the LDST; these had a higher mortality rate compared to patients with adequate cortisol production (70 vs 32%, p=0.034). Logistic regression analysis revealed that APACHE II ( p