Related Experiment Video

Updated: Jun 29, 2026

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

Published on: June 18, 2021

Pituitary-adrenal function in patients with acute subarachnoid haemorrhage: a prospective cohort study

Stepani Bendel¹, Timo Koivisto, Esko Ruokonen

¹Department of Intensive Care, Kuopio University Hospital and Kuopio University, Puijonlaaksontie 2, 70211 Kuopio, Finland. Stepani.Bendel@kuh.fi

Critical Care (London, England)

|October 15, 2008

Abstract

Introduction:

Subarachnoid haemorrhage (SAH) may damage the hypothalamo-pituitary-adrenal gland (HPA) axis and disturb cortisol metabolism. There are no available data that relates to the response of the HPA axis in the acute phase of SAH. We aimed to characterise the behavior of serum adrenocorticotropic hormone (ACTH), total cortisol, stimulated total cortisol and free cortisol concentrations in acute aneurysmal SAH.

Methods:

A prospective cohort study was conducted of patients with acute aneurysmal SAH (n = 30) admitted to a tertiary university hospital. Patients admitted for elective aneurysmal surgery (n = 16) served as the control group. An ACTH stimulation test was performed twice during the first week and at three months. The main outcome measure was description of the ACTH-cortisol response by calculating serum free cortisol and measuring total cortisol and ACTH concentrations. A mixed models method was used for testing between the groups, allowing heterogeneity between the groups.

Results:

Patients with SAH had higher initial serum total cortisol (mean +/- SD; 793 +/- 312 nmol/L) and free cortisol concentrations (83 +/- 55 nmol/L) than control patients (535 +/- 193 nmol/L, p = 0.001 and 33 +/- 18 nmol/L, p < 0.001, respectively). Thereafter, there were no differences in this respect. Serum free and total cortisol concentrations correlated but were unaffected by the severity of SAH. ACTH concentrations were comparable between SAH and control groups. Patients with Hunt-Hess grades IV to V had higher ACTH concentrations at day one (10.7 +/- 7.1 pmol/l/L) and day five (8.2 +/- 7.7 pmol/L) than patients with grade I-III (day one: 3.8 +/- 2.0 pmol/L, p = 0.002; day five: 4.7 +/- 1.8 pmol/L, p = 0.04).

Conclusions:

Calculation of serum free cortisol concentration was not helpful in identifying patients with potential hypocortisolism. SAH severity did not affect cortisol concentrations, possibly indicating relative pituitary-adrenal insufficiency in patients with more severe bleeding.

Trial Registration:

ClinicalTrials.gov Identifier NCT00614887.

More Related Videos

A Murine Model of Subarachnoid Hemorrhage

A Murine Model of Subarachnoid Hemorrhage

Published on: November 21, 2013

Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage

Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage

Published on: August 30, 2020

Related Concept Videos

Cushing Syndrome II: Pathophysiology

Cushing Syndrome II: Pathophysiology

Cortisol production is normally governed by the hypothalamic–pituitary–adrenal (HPA) axis, which maintains hormonal balance through tightly regulated feedback mechanisms. Disruption of this regulatory system is central to the development of Cushing syndrome, whether the excess cortisol originates from external medications or internal pathology. Persistent cortisol elevation alters metabolism, immune function, and endocrine signaling, producing the characteristic clinical features of the...

Hemorrhagic Stroke ll: Pathophysiology

Hemorrhagic Stroke ll: Pathophysiology

A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...

Hypothalamic-Pituitary Axis

Hypothalamic-Pituitary Axis

The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.

Articles linked to this work by shared authors, journal, and citation graph.

Management of Pain in the Intensive Care Unit: A Nordic Survey.

Acta anaesthesiologica Scandinavica·2026

Burr-Hole Drainage With or Without Irrigation for Chronic Subdural Hematoma, Postoperative Hematoma Volume, and Risk of Reoperation: A Post Hoc Analysis of the FINISH Trial.

Neurosurgery·2026

Preferences for Blood Glucose Management in Adult Intensive Care Unit Patients-An International Survey.

Acta anaesthesiologica Scandinavica·2026

The Glasgow Coma Scale as a predictor of mortality in intensive care: relevance of underlying cause of impaired consciousness.

Journal of critical care·2026

Early Prediction of Neurological Outcome After Cardiac Arrest-Rationale and Design of the Prospective International Observational EARLY-NEURO, a STEPCARE Substudy.

Acta anaesthesiologica Scandinavica·2026

Severity of Illness and Mortality According to Time of Admission to Intensive Care.

Acta anaesthesiologica Scandinavica·2026

See all related articles