[Effects of synthetic ACTH on plasma cortisol and aldosterone in neurosurgery]

Cerebral oedema, present or potential, is a predominant medical complication of neurosurgery. Its physiopathology and treatment can be in part linked to adrenal activity (aldosterone and sodium balance; cortisol and hormone treatments). In 25 non-comatose patients presenting with a tumoral or vascular neurosurgical condition, plasma cortisol and aldosterone levels were measured by radioimmunoassay, always at the same time (07 h), before any investigations or treatment were carried out, the patient being at rest. Cortisol levels were increased in more than half the patients (n = 14; 44.11 +/- 3.4 micrograms X 100 ml-1; p less than 0.001); aldosterone levels were high in one third of the patients (n = 8; 304.29 +/- 57 micrograms X ml-1; p less than 0.001). 17 of these patients were studied according to the protocol of the synthetic ACTH test during the first four days of their receiving 1 mg X 24 h-1 synthetic ACTH. The expected therapeutic effect on cortisol was not obtained in all cases, and the stimulation of aldosterone release was important and prolonged.