Relative adrenal insufficiency amongst hospitalized mild to moderate acute ischemic stroke patients

Norasyikin A. Wahab @ A. Rahman, Nor Azmi Kamaruddin, Norlela Sukor, Suehazlyn Zainudin, Amiliyaton Mohd Razali, Norlaila Mustafa, Wan Nur Nafisah Wan Yahya, Nor Azmi Kamaruddin

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2 Citations (Scopus)

Abstract

Introduction: Acute ischemic stroke is a stressful condition where there is marked increase in the production of Cortisol. In the past, adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date, there have been no studies performed to determine its prevalence among patients with acute ischemic stroke. Objectives: The aim of this study was to determine the prevalence of relative adrenal insufficiency in acute ischemic stroke by utilizing low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality. Method: Fifty-eight patients who fulfilled the diagnosis of acute ischemic stroke within 72 hours from the onset of a stroke were subjected to LD (1ug) synacthen test (LDST) and two hours later toSD (250 ug) synacthen test (SDST). Result: Based on an increment of less than 250 nmol/L after LDST, 38 (65.5%) patients had relative adrenal insufficiency. However, using similar criteria with the SDST, only 18 (31.0%) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline Cortisol levels. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes. Conclusion: This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischemic stroke patients. Utilizing the LDST, relative adrenal insufficiency was found more sensitive in detecting relative adrenal insufficiency in patients with acute ischemic stroke as compared to SDST.

Original languageEnglish
Pages (from-to)89-93
Number of pages5
JournalArchives of Iranian Medicine
Volume18
Issue number2
Publication statusPublished - 2014

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Adrenal Insufficiency
Stroke
Hydrocortisone
Morbidity
Hospital Mortality
Critical Illness
Inpatients
Cross-Sectional Studies
Mortality

Keywords

  • Adrenal insufficiency
  • Ischemic stroke
  • Low dose synacthen test
  • Standard dose synacthen test
  • Synacthen test

ASJC Scopus subject areas

  • Medicine(all)

Cite this

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title = "Relative adrenal insufficiency amongst hospitalized mild to moderate acute ischemic stroke patients",
abstract = "Introduction: Acute ischemic stroke is a stressful condition where there is marked increase in the production of Cortisol. In the past, adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date, there have been no studies performed to determine its prevalence among patients with acute ischemic stroke. Objectives: The aim of this study was to determine the prevalence of relative adrenal insufficiency in acute ischemic stroke by utilizing low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality. Method: Fifty-eight patients who fulfilled the diagnosis of acute ischemic stroke within 72 hours from the onset of a stroke were subjected to LD (1ug) synacthen test (LDST) and two hours later toSD (250 ug) synacthen test (SDST). Result: Based on an increment of less than 250 nmol/L after LDST, 38 (65.5{\%}) patients had relative adrenal insufficiency. However, using similar criteria with the SDST, only 18 (31.0{\%}) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline Cortisol levels. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes. Conclusion: This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischemic stroke patients. Utilizing the LDST, relative adrenal insufficiency was found more sensitive in detecting relative adrenal insufficiency in patients with acute ischemic stroke as compared to SDST.",
keywords = "Adrenal insufficiency, Ischemic stroke, Low dose synacthen test, Standard dose synacthen test, Synacthen test",
author = "{A. Wahab @ A. Rahman}, Norasyikin and Kamaruddin, {Nor Azmi} and Norlela Sukor and Suehazlyn Zainudin and {Mohd Razali}, Amiliyaton and Norlaila Mustafa and {Wan Yahya}, {Wan Nur Nafisah} and Kamaruddin, {Nor Azmi}",
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T1 - Relative adrenal insufficiency amongst hospitalized mild to moderate acute ischemic stroke patients

AU - A. Wahab @ A. Rahman, Norasyikin

AU - Kamaruddin, Nor Azmi

AU - Sukor, Norlela

AU - Zainudin, Suehazlyn

AU - Mohd Razali, Amiliyaton

AU - Mustafa, Norlaila

AU - Wan Yahya, Wan Nur Nafisah

AU - Kamaruddin, Nor Azmi

PY - 2014

Y1 - 2014

N2 - Introduction: Acute ischemic stroke is a stressful condition where there is marked increase in the production of Cortisol. In the past, adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date, there have been no studies performed to determine its prevalence among patients with acute ischemic stroke. Objectives: The aim of this study was to determine the prevalence of relative adrenal insufficiency in acute ischemic stroke by utilizing low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality. Method: Fifty-eight patients who fulfilled the diagnosis of acute ischemic stroke within 72 hours from the onset of a stroke were subjected to LD (1ug) synacthen test (LDST) and two hours later toSD (250 ug) synacthen test (SDST). Result: Based on an increment of less than 250 nmol/L after LDST, 38 (65.5%) patients had relative adrenal insufficiency. However, using similar criteria with the SDST, only 18 (31.0%) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline Cortisol levels. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes. Conclusion: This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischemic stroke patients. Utilizing the LDST, relative adrenal insufficiency was found more sensitive in detecting relative adrenal insufficiency in patients with acute ischemic stroke as compared to SDST.

AB - Introduction: Acute ischemic stroke is a stressful condition where there is marked increase in the production of Cortisol. In the past, adrenal insufficiency in critically ill patients had been shown to be associated with significant morbidity and mortality. To date, there have been no studies performed to determine its prevalence among patients with acute ischemic stroke. Objectives: The aim of this study was to determine the prevalence of relative adrenal insufficiency in acute ischemic stroke by utilizing low dose (LD) and standard dose (SD) synacthen tests and to correlate it with inpatient hospital morbidity and mortality. Method: Fifty-eight patients who fulfilled the diagnosis of acute ischemic stroke within 72 hours from the onset of a stroke were subjected to LD (1ug) synacthen test (LDST) and two hours later toSD (250 ug) synacthen test (SDST). Result: Based on an increment of less than 250 nmol/L after LDST, 38 (65.5%) patients had relative adrenal insufficiency. However, using similar criteria with the SDST, only 18 (31.0%) patients had relative adrenal insufficiency. Three patients died during the study period and they had a tendency to have high baseline Cortisol levels. The diagnosis of relative adrenal insufficiency in general was not associated with any other significant clinical outcomes. Conclusion: This is the first study demonstrating the prevalence of relative adrenal insufficiency amongst acute ischemic stroke patients. Utilizing the LDST, relative adrenal insufficiency was found more sensitive in detecting relative adrenal insufficiency in patients with acute ischemic stroke as compared to SDST.

KW - Adrenal insufficiency

KW - Ischemic stroke

KW - Low dose synacthen test

KW - Standard dose synacthen test

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