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Published on: November 19, 2020
Endocrine alterations in critically ill patients with stroke during the early recovery period
Ioanna Dimopoulou1, Andreas T Kouyialis, Stylianos Orfanos
1Department of Critical Care Medicine, Evangelismos Hospital, National & Kapodistrian University of Athens Medical School, Athens, Greece. idimo@otenet.gr
Introduction:
Endocrine abnormalities in critically ill patients with stroke during the early recovery period have not been well characterized.
Methods:
To investigate this issue, 33 consecutive mechanically ventilated patients (27 men) with hemorrhagic (n = 21) or ischemic (n = 12) stroke having a mean age of 57 +/- 12 years were studied. Glasgow Coma Scale score on admission in the hospital was 8 +/- 3. The following basal hormones were measured within 72 hours postextubation: cortisol, corticotropin (ACTH), free thyroxine, tri-iodothyronine, thyroid-stimulating hormone, testosterone, estradiol, follicle-stimulating hormone, luteinizing hormone, growth hormone, and insulin-like growth factor (IGF)-1. Subsequently, a low-dose (1 microg) ACTH stimulation test was performed.
Results:
Twenty-six (79%) patients showed endocrine alterations. The most common change was low IGF-1 levels compatible with growth hormone deficiency (45%), followed by hypogonadism (39%), thyroid dysfunction (36%), and cortisol hyporesponsiveness (33%).
Conclusion:
Neuroendocrine changes occur with high frequency in critically ill patients with stroke during the early recovery period. It remains to be determined whether these changes have implications for functional and/or clinical outcome.
